Standardized Assessment Protocol Research Articles

Standardized Ultrasound Evaluation for Active Surveillance of Low-Risk Thyroid Microcarcinoma in Adults: 2024 Korean Society of Thyroid Radiology Consensus Statement.

Active surveillance (AS) has been widely adopted as an alternative to immediate surgery owing to the indolent nature and favorable outcomes of papillary thyroid microcarcinoma (PTMC). AS is generally recommended for tumors measuring ≤1 cm without aggressive cytological subtypes, risk of gross extrathyroidal extension (ETE), lymph node metastasis (LNM), or distant metastasis. AS requires careful patient selection based on various patient and tumor characteristics, and ultrasound (US) findings. Moreover, during AS, regular US is performed to monitor any signs of tumor progression, including tumor growth, new US features of potential gross ETE, and LNM. Therefore, appropriate imaging-based assessment plays a crucial role in determining whether AS or surgery should be pursued. However, detailed recommendations concerning US evaluation are currently insufficient, necessitating the formulation of this guideline. The Korean Society of Thyroid Radiology has developed a consensus statement for low-risk PTMC, covering US assessment methods when considering AS as a management option and conducting follow-up imaging tests during AS. This guideline aims to provide optimal scientific evidence and expert opinion consensus regarding a standardized US-based assessment protocol for low-risk PTMC.

Audiometric Profiles Across a Clinical Population of Children With Hyperacusis.

Hyperacusis (sound sensitivity) is well documented among adults, but little is known about hyperacusis in children. Here, we assess relationships among the presence of hyperacusis, audiometric profiles, and nonauditory factors in a pediatric clinical population. A retrospective review of clinical records from 329 children, ages 2-17 years, was performed to assess the prevalence of hyperacusis and correlations among hearing status, behavioral or communication concerns, and the presence of hyperacusis. In 329 study participants, 18% reported hyperacusis (58% male and 42% female). No significant sex or age differences were found. Hyperacusis was more likely to occur alongside normal hearing or with unilateral hearing loss relative to bilateral hearing loss. Among children with hyperacusis, there was a high prevalence of audiovestibular problems, mental health concerns, speech and language delays, difficulty in school, and behavioral problems. Tinnitus was also found to be comorbid with hyperacusis, but the comorbidity was less than that reported in adults. This study identified common hearing profiles and critical comorbidities in a large clinical cohort of children with hyperacusis. These results demonstrate the urgent need for standardized multidisciplinary assessment and treatment protocols for pediatric hyperacusis.

Subjective performance assessment protocol for visual explanations-based face verification explainability

The integration of Face Verification (FV) systems into multiple critical moments of daily life has become increasingly prevalent, raising concerns regarding the transparency and reliability of these systems. Consequently, there is a growing need for FV explainability tools to provide insights into the behavior of these systems. FV explainability tools that generate visual explanations, e.g., saliency maps, heatmaps, contour-based visualization maps, and face segmentation maps, show promise in enhancing FV transparency by highlighting the contributions of different face regions to the FV decision-making process. However, evaluating the performance of such explainability tools remains challenging due to the lack of standardized assessment metrics and protocols. In this context, this paper proposes a subjective performance assessment protocol for evaluating the explainability performance of visual explanation-based FV explainability tools through pairwise comparisons of their explanation outputs. The proposed protocol encompasses a set of key specifications designed to efficiently collect the subjects’ preferences and estimate explainability performance scores, facilitating the relative assessment of the explainability tools. This protocol aims to address the current gap in evaluating the effectiveness of visual explanation-based FV explainability tools, providing a structured approach for assessing their performance and comparing with alternative tools. The proposed protocol is exercised and validated through an experiment conducted using two distinct heatmap-based FV explainability tools, notably FV-RISE and CorrRISE, taken as examples of visual explanation-based explainability tools, considering the various types of FV decisions, i.e., True Acceptance (TA), False Acceptance (FA), True Rejection (TR), and False Rejection (FR). A group of subjects with variety in age, gender, and ethnicity was tasked to express their preferences regarding the heatmap-based explanations generated by the two selected explainability tools. The subject preferences were collected and statistically processed to derive quantifiable scores, expressing the relative explainability performance of the assessed tools. The experimental results revealed that both assessed explainability tools exhibit comparable explainability performance for FA, TR, and FR decisions with CorrRISE performing slightly better than FV-RISE for TA decisions.

Patient-reported outcome measures and physical function following head and neck lymphedema - a systematic review.

Head and neck cancer (HNC) treatments often lead to significant morbidity, including lymphedema. This systematic review aims to comprehensively explore the prevalence and impact of head and neck lymphedema (HNL) following treatment. A systematic literature search was conducted up to September 2023. Studies evaluating HNL prevalence, associated factors, impact, patient-reported outcomes (PROMs), and physical assessments were included. Methodological quality assessment was performed, and data were synthesised narratively. Twelve studies met the inclusion criteria, with methodological quality ranging from moderate to high. Internal lymphedema prevalence was consistently higher than external lymphedema, with varying rates attributed to treatment modalities and assessment methods. PROMs such as the Lymphedema Symptom Intensity and Distress-Head and Neck and physical assessments including Patterson's Rating Scale were commonly utilised. HNL significantly impacted quality of life and physical function, with reported symptoms including discomfort, tightness, swallowing difficulties, and psychological distress. HNL is a common sequela of HNC treatment with significant implications for individuals' QoL. Standardised assessment protocols and tailored interventions are needed to address the needs of individuals with HNL and improve overall outcomes. This systematic review highlights a significant prevalence of lymphedema, particularly internal lymphedema in the larynx and pharynx, following treatment. Swallowing difficulties, nutritional issues, anxiety, depression, and body image concerns were associated with both internal and external lymphedema. The impact on quality of life is substantial, with survivors experiencing physical symptoms and psychosocial challenges, emphasising the importance of integrated care approaches tailored to both aspects of well-being.

Optimizing Pain Management in Emergency Departments: A Comprehensive Review of Current Analgesic Practices.

Effective pain management in Emergency Departments (EDs) is vital for improving patient comfort and clinical outcomes. This review provides a comprehensive analysis of current pain management practices in ED settings, focusing on the challenges and opportunities for optimization. The review examines pharmacologic and non-pharmacologic pain management strategies, evaluating their effectiveness and identifying inconsistencies and gaps in current practices. Key challenges in the ED environment include time constraints, variability in clinical protocols, and the need to address diverse patient needs, including those of paediatric, geriatric, and chronic pain patients. The review highlights the importance of standardized pain assessment tools and protocols to improve consistency in pain management. Innovations, such as technological advances and multimodal approaches, are explored for their potential to enhance pain management practices. Recommendations address identified challenges, including improved training for ED staff, the development of evidence-based protocols, and the integration of multimodal pain management strategies. By addressing these areas, the review aims to contribute to the development of more effective and uniform pain management practices in emergency care, ultimately leading to better patient outcomes and experiences. This review emphasizes the need for ongoing research and adaptation of best practices to meet the evolving needs of patients in emergency settings.

Mental health disparities in people living with human immunodeficiency virus: A cross-sectional study on physician-patient concordance and treatment regimens.

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) can profoundly affect the mental health of the people living with HIV (PLWH), with higher rates of anxiety, depression, and sleep disturbances. The disparities in neuropsychological problems evaluated by physicians and self-assessed by patients are still unknown. A total of 5000 PLWH and 500 physicians from 167 hospitals were enrolled in this cross-sectional study from September 2022 to February 2023. 4-Item Patient Health Questionnaire (PHQ-4) was used for the evaluation of depressive issues and anxiety issues by PLWH. Each physician assessed 10 PLWH under their care for the presence of depressive or anxiety issues. The primary outcomes of this study are the concordance rates on the depressive issues and anxiety issues evaluation between physicians and PLWH. The Cohen's kappa test was used to assess the agreement between physicians and PLWH. The concordance rate for the evaluation of depressive issues is 73.84% (95% confidence interval [CI]: 72.60-75.04%), and it is significantly different from the expected rate of 80% (P<0.001). Similarly, the concordance rate for the evaluation of anxiety issues is 71.74% (95% CI: 70.47-72.97%), which is significantly different from the expected rate of 80% as per the null hypothesis (P<0.001). The overestimation rate by physicians on depressive issues is 12.20% (95% CI: 11.32-13.14%), and for anxiety issues is 12.76% (95% CI: 11.86-13.71%). The mismatch rate for depressive issues is 26.16% (95% CI: 24.96-27.40%), and for anxiety issues is 28.26% (95% CI: 27.02-29.53%). The underestimation rate by physicians on depressive issues is 13.96% (95% CI: 13.03-14.95%), and for anxiety issues is 15.50% (95% CI: 14.52-16.53%). For the treatment regiments, PLWH sustained on innovative treatment regimen (IR) related to a lower prevalence of depressive issues (odds ratio [OR]=0.71, 95% CI: 0.59-0.87, P=0.003) and a lower prevalence of anxiety issues (OR=0.63, 95% CI: 0.52-0.76, P<0.001). PLWH switch from conventional treatment regimen (CR) to IR also related to a lower prevalence of depressive issues (OR=0.79, 95% CI: 0.64-0.98) and a lower prevalence of anxiety issues (OR=0.81, 95% CI: 0.67-0.99). Nearly one in three PLWH had their condition misjudged by their physicians. The findings underscore the need for improved communication and standardized assessment protocols in the care of PLWH, especially during the acute phase of HIV infection.

Using the RE-AIM and TDF frameworks to evaluate the implementation of a standardized cognitive assessment protocol in outpatient rehabilitation.

Impairments in cognition significantly affect patient functioning and rehabilitation outcomes. Assessment is essential to identifying at-risk individuals and guiding care plans. A cognitive assessment protocol was implemented in occupational therapy (OT) and speech-language pathology (SLP) outpatient practice. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and Theoretical Domains Framework (TDF), this study (1) measured the reach and adoption of the cognitive assessment protocol and (2) explored determinants and strategies that may affect adoption. Sequential mixed methods. Two outpatient rehabilitation clinics (A and B) within a health care network. Medical records from 220 adult patients with neurologic diagnosis and 15 OT and SLP clinicians. Cognitive assessment protocol. Reach of the assessment protocol across patient characteristics and adoption across clinical sites were measured quantitatively via retrospective electronic medical records review. Qualitative data on effectiveness and the implementation process were collected via clinician focus groups. Protocol adoption rates were 71% and 54% at clinics A and B, respectively. Site B OT was more likely to be noncompliant with protocol adoption compared to Site A, when controlling for patient characteristics, (81% vs. 16%, respectively; odds ratio = 11.4, 95% confidence interval [3.36-38.64], p ≤ .001). Patient age was a significant factor for protocol reach; older age was associated with noncompliance of the SLP protocol adoption, p < .05. Both sites employed implementation strategies targeting the provider level (eg, education/training); Site A additionally included organization-level strategies (eg, leadership engagement). In the absence of organization-level strategies, OT and SLP clinicians at Site B identified barriers related to leadership support, resources, and workflow. Standardized practice protocols are feasible to implement within the rehabilitation setting, though multilevel implementation strategies may be needed to promote adoption. Aligning practices with the needs, values and priorities of the organization, providers, and patients and families is imperative.

The role of corneal epithelial thickness in ocular surface health

Abstract The corneal epithelium (CE), which is made up of five to seven layers, is crucial for maintaining the integrity of the cornea and the health of the ocular surface. The present review delves into the importance of corneal epithelial thickness (CET) in the identification and treatment of a range of ocular surface diseases (OSDs), such as keratoconus (KCN), dry eye disease (DED), and the aftermath of refractive procedures. Spectral-domain optical coherence tomography (SD-OCT) can be used to provide reliable and precise CET values, providing valuable insights into epithelial remodeling patterns and their correlation with disease severity. In DED, CE irregularities correlate with clinical symptoms, revealing a distinctive thinning pattern in the superior epithelium, especially in severe cases. This is attributed to mechanical friction from frequent blinking. Contrasting studies on overall CET in DED patients highlight the need for standardized assessment protocols. In KCN, epithelial thickness mapping (ETM) demonstrates specific thinning patterns, aiding in early detection and management. Postrefractive surgery, epithelial remodeling contributes to residual refractive errors, emphasizing the epithelium’s role in compensating for stromal irregularities. This review underscores the importance of CET analysis in clinical practice, advocating for the integration of advanced imaging technologies like SD-OCT. Understanding the dynamic changes in CET can enhance early diagnosis, guide surgical decisions, and improve treatment outcomes for various OSDs, ultimately contributing to better ocular health maintenance.

Providing ramps during lay has larger impacts on laying hens than ramps at rearing

Commercial laying hen housing is shifting from traditional cages to non-cage housing systems, such as the aviary, which has gained popularity due to potential for more species-typical behavior. However, birds housed in aviaries may have difficulties moving through the vertical tiers of the system leading to health problems such as keel bone fracture (KBF). One possible way to improve movement is to add ramps into an aviary system, allowing hens to walk between tiers rather than jump or fly. The objective of this study was to evaluate the impact of adding ramps to rearing and laying aviaries on bird health, production, and movement across vertical tiers of the aviary. Lohmann Selected Leghorn pullets were raised in 2 treatments: 4 pens (600 birds/pen) were raised with wire mesh ramps to aid movement between aviary tiers (RR) and 4 pens (600 birds/pen) were raised without ramps (RO). At 17 wk of age (WOA), birds were moved to the laying facility, in which 16 aviary pens with 225 birds/pen were populated. Half the pens (n = 8) were supplemented with wire mesh ramps (LR) and the other half were not (LO). Within each laying treatment group, 4 pens were populated with RR hens and 4 pens were populated with RO hens, creating 4 treatment combinations (RRLR, RRLO, ROLR, ROLO). From each pen, 15 focal hens were selected for radiographic imaging of their keel bones taken at 21, 36, 45, and 60 WOA and the images were subsequently scored for KBF severity. Focal hens were also scored for feather condition and footpad quality at 36 and 60 WOA using a standardized welfare assessment protocol. The number of downward transitions among aviary areas and falls were recorded at 19 to 20 and 30 to 31 WOA. Data were analyzed using (generalized) linear mixed models in R software. When ramps were available, they were used in most of the observed downward transitions (79% in ROLR and 86% in RRLR). Hens who received ramps in lay (i.e., RRLR and ROLR) showed more transitions immediately after lights on compared to midday or dusk phases (p < 0.001), performed more transitions from the first aviary tier compared to nest or top tier (p = 0.013) and had lower KBF severity than those who did not receive ramps in the laying aviaries (ROLO, RRLO; p < 0.001). At 60 WOA, hens in the RRLR treatment had greater feather coverage than those in ROLR and RRLO treatments (p < 0.001). Birds in the RRLR treatment had better foot health overall than those in treatments without ramps in lay (p = 0.018). Providing ramps to hens in aviaries appeared to be the preferred means of transitioning between aviary tiers though had positive effects on welfare parameters such as food health, feather coverage, and KBF severity, without negative impacts on production. Benefits were seen primarily when ramps were provided in lay, though their installation in rearing provided evidence of easier adaptation to the laying barn. Our study supports providing ramps throughout the lifetime of the bird to accommodate hens' preferred means of moving vertically in aviaries and deliver consequent benefits to health and welfare.

Tracking the quality of graphene oxide suspension during long-term storage

Graphene oxide is a popular material because of not only its cost–efficient production but also its unique properties. However, after long-term storage, several changes occur in the structure of graphene oxide obtained using the modified Hummers’ method, affecting its stability and physicochemical properties. Despite the obvious problem, there is only a limited number of works devoted to ageing factors, their impact on the properties and structure of graphene oxide itself, and operational modes of materials and devices based on graphene oxide. Therefore, to facilitate the widespread industrial application of graphene oxide, it is crucial to establish standardized protocols for storage and quality assessment of graphene oxide. In this paper, the prepared samples were extensively characterized using various techniques, including transmission electron microscopy, X-ray photoelectron spectroscopy, UV–Vis and fluorescence spectroscopy techniques. Among the various analytical methods, comprehensive spectroscopic analysis of the absorption and fluorescence properties has proven to be the most sensitive to sample ageing. We investigated the change in optical and physicochemical properties of graphene oxide during its long-term storage under various conditions. It was found that graphene oxide precipitated during storage, and the O/C ratio in graphene oxide decreased slightly from 0.49 to 0.47. Still, the type of oxygen-containing functional groups did not change, which might indicate possible intra-structural changes. Using transmission electron microscopy, molecular dynamic and density functional theory simulation, we showed that the rearrangement of functional groups on the surface leads to the formation of large sp2 domains that interact with each other, leading to aggregation of the graphene oxide.

Expert consensus on the terminology, diagnostics and management of persisting symptoms after concussion with a focus on mental health, postural stability, electroencephalogram and balance testing: A cross-sectional Delphi-like survey.

Persisting symptoms after concussion (PSaC) are a pathological manifestation of head injuries that present with symptoms after the acute phase of head trauma has subsided. Insufficient research about PSaC has led to gaps in knowledge and incorrect terminology being applied. Furthermore, gaps exist in standardised assessment protocols and understanding of mental health symptoms associated with sports. The study aimed to; 1) Determine expert consensus on appropriate terminology for symptoms lasting >4 weeks, 2) Investigate associations with mental health and postural stability symptoms, 3) Evaluate experts' views on quantitative balance and electroencephalogram (EEG) testing. A Delphi-like survey was designed in REDCap and sent to identified experts in the field of sports-related concussions (SRC). Expert consensus was defined as ≥75% agreement. Expert consensus identified the following mood and motor control symptoms being associated with PSaC: increases in emotional state (80%), irritability (87%), nervousness (87%), sadness (80%), balance impairment (80%), dizziness (87%) and feeling slow (80%). Numbness and tingling were not considered longer-term effects (80%). Additionally, 93% of respondents acknowledged mental health symptoms as potential longer-term effects, with 80% agreeing on inadequate current management. Respondents indicated PSaC are only somewhat adequately managed (73%) or not managed well enough (27%). The use of EEG and quantitative balance testing remains open for debate. The survey response rate was 21%. Improving mental health management for athletes with PSaC and standardising terminology is crucial. Future research is required to establish effective diagnosis and treatment methods. Addressing these issues may result in better care and safer return to play for athletes.

A novel case of Takenouchi-Kosaki syndrome: Focus on hearing and language rehabilitation

Abstract Takenouchi-Kosaki syndrome (TKS) is a rare congenital condition, caused by a mutation in the cell division cycle 42 gene. This gene typo impacts various physiological processes, including hearing, hematopoiesis, immunologic functioning, and neurodevelopment. Despite the high prevalence of hearing impairment in TKS, existing literature has concentrated primarily on pharmacological treatments for hematoimmunologic diseases. This case report presents a novel case of TKS, highlighting the importance of audiological assessment and rehabilitating interventions in children with TKS. We discuss the case of a prematurely born boy who was diagnosed with TKS and who presented with profound bilateral sensorineural hearing loss and associated developmental delays. Following comprehensive audiological evaluation and intervention – including hearing aids, sign language, and alternative augmentative communication systems – a multidisciplinary approach was adopted to enhance his communicative abilities. From this study, it emerges the increasing need for tailored rehabilitation strategies for TKS patients to improve communication skills and overall quality of life. Further researches are needed to develop standardized protocols for assessment and treatment in patients with TKS.

The unseen impact - a deep dive into neurocognitive impairment among patients with intracranial meningiomas: a comprehensive systematic review of the literature.

Meningiomas are the most common intracranial tumors, predominantly affecting adults, with a higher incidence in female and elderly populations. Despite their prevalence, research on neurocognitive impairment in meningioma patients remains limited compared to intra-axial tumors such as gliomas. We conducted a comprehensive systematic review of the current literature on neurocognitive outcomes in meningioma patients pre- and post-surgery. Our review revealed significant disparities in reported neurocognitive outcomes, with prospective studies suggesting tumor-related factors as the primary contributors to postoperative deficits, while retrospective studies imply surgical intervention plays a significant role. Regardless of study design or specifics, most studies lack baseline preoperative neurocognitive assessments and standardized protocols for evaluating neurocognitive function. To address these gaps, we advocate for standardized neurocognitive assessment protocols, consensus on neurocognitive domains to be targeted in this population by tailored test batteries, and more prospective studies to elucidate correlations between tumor characteristics, patient attributes, surgical interventions, neurocognitive status, and planning for implementing tailored neurocognitive rehabilitation strategies early in the postoperative course which is crucial for achieving optimal long-term neurocognitive outcomes and enhancing patients' quality of life.

Food Addiction Screening, Diagnosis and Treatment: A Protocol for Residential Treatment of Eating Disorders, Substance Use Disorders and Trauma-Related Psychiatric Comorbidity.

Food addiction, or ultra-processed food addiction (UPFA), has emerged as a reliable and validated clinical entity that is especially common in individuals seeking treatment for eating disorders (EDs), substance use disorders (SUDs) and co-occurring psychiatric disorders (including mood, anxiety and trauma-related disorders). The clinical science of UPFA has relied on the development and proven reliability of the Yale Food Addiction Scale (YFAS), or subsequent versions, e.g., the modified YFAS 2.0 (mYFAS2.0), as well as neurobiological advances in understanding hedonic eating. Despite its emergence as a valid and reliable clinical entity with important clinical implications, the best treatment approaches remain elusive. To address this gap, we have developed and described a standardized assessment and treatment protocol for patients being treated in a residential program serving patients with psychiatric multi-morbidity. Patients who meet mYFAS2.0 criteria are offered one of three possible approaches: (1) treatment as usual (TAU), using standard ED treatment dietary approaches; (2) harm reduction (HR), offering support in decreasing consumption of all UPFs or particular identified UPFs; and (3) abstinence-based (AB), offering support in abstaining completely from UPFs or particular UPFs. Changes in mYFAS2.0 scores and other clinical measures of common psychiatric comorbidities are compared between admission and discharge.

A Scoping Review of PTSD and Depression in Adult Burn Patients: A Call for Standardized Screening and Intervention Research.

Despite the growing incidence of burn injuries globally and the advancements in physical recovery, the psychological aspect of burn trauma recovery remains inadequately addressed. This review aims to consolidate existing literature posttraumatic stress disorder (PTSD) and depression in adult burn survivors, recognizing the need for a holistic approach to burn recovery that encompasses both physical and mental health. The comprehensive analysis of 156 studies revealed significant variations in methodological approaches, leading to challenges in creating standardized protocols for mental health assessment in burn care. Key findings include the identification of a wide range of psychological assessment tools and a substantial research gap in low and middle-income countries, where the majority of burn injuries occur. Only 7.0% of the studies assessed interventions for PTSD or depression, indicating a lack of focus on treatment modalities. The studies identified demographic factors, patient history, psychosocial factors, burn injury characteristics, and treatment course as risk factors for PTSD and depression post-burn injury. The review highlights the need for early screening, intervention, and attention to subjective experiences related to burn injury, as these are strong predictors of long-term psychological distress. It also emphasizes the complexity of addressing psychological distress in burn survivors and the need for more standardized practices in assessing PTSD and depression specific to this population.

Protocol-based assessment and management of first episode psychosis: Comparison of short and medium-term outcomes in psychopathology, quality of life, functioning and family burden across two sites in India

BackgroundStandard assessment and management protocols exist for first episode psychosis (FEP) in high income countries. Due to cultural and resource differences, these need to be modified for application in low-and middle-income countries. AimsTo assess the applicability of standard assessment and management protocols across two cohorts of FEP patients in North and South India by examining trajectories of psychopathology, functioning, quality of life and family burden in both. MethodFEP patients at two sites (108 at AIIMS, North India, and 115 at SCARF, South India) were assessed using structured instruments at baseline, 3, 6 and 12 months. Standard management protocols consisted of treatment with antipsychotics and psychoeducation for patients and their families. Generalised estimating equation (GEE) modelling was carried out to test for changes in outcomes both across and between sites at follow-up. ResultsThere was an overall significant improvement in both cohorts for psychopathology and other outcome measures. The trajectories of improvement differed between the two sites with steeper improvement in non-affective psychosis in the first three months at SCARF, and affective symptoms in the first three months at AIIMS. The reduction in family burden and improvement in quality of life were greater at AIIMS than at SCARF during the first three months. ConclusionsDespite variations in cultural contexts and norms, it is possible to implement FEP standard assessment and management protocols in North and South India. Preliminary findings indicate that FEP services lead to significant improvements in psychopathology, functioning, quality of life, and family burden within these contexts.

The Pathophysiology and Management of Pathologic Scarring-a Contemporary Review.

Significance: Pathologic scarring occurs secondary to imbalances in the cellular mechanisms of wound healing and affects millions of people annually. This review article aims to provide a concise overview of the pathophysiology and management of pathologic scarring for clinicians and scientists alike. Recent Advances: Contemporary research in the field has identified aberrations in transforming growth factor-β/small mothers against decapentaplegic (TGF-β/SMAD) signaling pathways as key drivers of pathologic scar formation; indeed, this pathway is targeted by many treatment modalities and translational investigations currently underway. Although intralesional injection of corticosteroids has been the gold standard in the treatment of pathologic scarring, studies show greater treatment efficacy with the use of combination injections such as triamcinolone/5-fluorouracil and triamcinolone/botulinum toxin. Adjunctive therapies including ablative fractional carbon dioxide/erbium-doped yttrium aluminum garnet and non-ablative pulsed-dye lasers, microneedling, and carboxytherapy have shown encouraging results in small cohort studies. Translational investigations involving the use of nanogels, RNA interference, and small molecules targeting TGF-β/SMAD pathways are also currently underway and hold promise for the future. Critical Issues: The heterogeneous nature of hypertrophic scars and keloids poses significant challenges in formulating standardized treatment and assessment protocols, thereby limiting the conclusions that can be drawn. Future Directions: Rigorous clinical trials into the individual and synergistic effects of these therapies would be ideal before any definitive conclusions or evidence-based treatment recommendations can be made. Owing to the heterogeneity of the pathology and patient population, well-conducted cohort studies may be the next best option.

Auditory and language features in children with 18q deletion: Our experience and a brief review of the literature

Abstract 18q deletion is a rare genetic condition that occurs approximately 1 in 40,000 live births. The aim of this study is to describe four cases of 18q deletion, analyzing their auditory and language skills. A secondary aim is to compare our findings with those reported in the literature in order to propose a standardized assessment protocol and guidelines for auditory treatment and rehabilitation. All children underwent a detailed audiological evaluation including otoscopy, pure-tone audiometry, and auditory brainstem responses. We also administered language and speech tests according to the children’s age and skills. Comorbidities and disease severity varied depending on the genetic mutation. Data from the literature review are consistent with our findings. Therefore, the type of auditory rehabilitation changed among patients. Despite the heterogeneity of phenotypes and severity, hearing loss and stenotic external auditory canals were detected in all our patients with 18q deletion. Accurate diagnosis and follow-up are mandatory to improve auditory and language skills and quality of life. Due to the complexity of the cases, no standardized assessment protocols or treatment can be routinely proposed.

Envisioning the Future of ChatGPT in Healthcare: Insights and Recommendations from a Systematic Identification of Influential Research and a Call for Papers

Background and Aims: ChatGPT represents the most popular and widely used generative artificial intelligence (AI) model that received significant attention in healthcare research. The aim of the current study was to assess the future trajectory of the needed research in this domain based on the recommendations of the top influential published records.&#x0D; Materials and Methods: A systematic search was conducted on Scopus, Web of Science, and Google Scholar (27–30 November 2023) to identify the top ten ChatGPT-related published records in healthcare across the three databases. Classification of the records as “top” denoting high influence in the field was based on citation counts.&#x0D; Results: A total of 22 unique records from 17 different journals representing 14 different publishers were identified as the top ChatGPT-related publications in healthcare subject. Based on the identified records’ recommendations, the following themes appeared as important areas to consider in future ChatGPT research in healthcare: improving healthcare education, improved efficiency of clinical processes (e.g., documentation), addressing ethical concerns (e.g., patient privacy and consent), supporting research tasks (e.g., data analysis, manuscript preparation), mitigating ChatGPT output biases, improving patient education and engagement, and developing standardized assessment protocols for ChatGPT utility in healthcare.&#x0D; Conclusions: The current review highlighted key areas to be prioritized in assessment of ChatGPT utility in healthcare. Interdisciplinary collaborations and standardizing methodologies are needed to synthesize robust evidence in these studies. Based on these recommendations and the promising potential of ChatGPT on healthcare, JMJ launched a call for papers for a special issue entitled “Evaluating Generative AI-Based Models in Healthcare”.

Using ultrasound shear wave elastography to characterize peripheral nerve mechanics: a systematic review on the normative reference values in healthy individuals.

Ultrasound shear wave elastography (SWE) is an emerging non-invasive imaging technique for peripheral nerve evaluation. Shear wave velocity (SWV), a surrogate measure of stiffness, holds promise as a biomarker for various peripheral nerve disorders. However, to maximize its clinical and biomechanical value, it is important to fully understand the factors that influence nerve SWV measurements. This systematic review aimed to identify the normal range of SWV for healthy sciatic and tibial nerves and to reveal the factors potentially affecting nerve SWV. An electronic search yielded 17 studies eligible for inclusion, involving 548 healthy individuals (age range, 17 to 72 years). Despite very good reliability metrics, the reported SWV values differed considerably across studies for the sciatic (1.9-9.9 m/s) and tibial (2.3-9.1 m/s) nerves. Factors such as measurement proximity to joint regions, limb postures inducing nerve axial stretching, and transducer alignment with nerve fiber orientation were associated with increased SWV. These findings suggest regional-specific nerve mechanical properties, non-linear elastic behaviour, and marked mechanical anisotropy. The impact of age and sex remains unclear and warrants further investigation. These results emphasize the importance of considering these factors when assessing and interpreting nerve SWE. While increased SWV has been linked to pathological changes affecting nerve tissue mechanics, the significant variability observed in healthy nerves highlights the need for standardized SWE assessment protocols. Developing guidelines for enhanced clinical utility and achieving a comprehensive understanding of the factors that influence nerve SWE assessments are critical in advancing the field.