Standard Recommendations Research Articles

Isolated posterior stabilization of the pelvic ring in type III/IV fragility fractures of the pelvis are beneficial compared to 360° antero-posterior surgical approaches. A dual-center cohort analysis.

BackgroundFragility fractures of the pelvis (FFP) in elderly patients are an increasing concern due to their association with osteoporosis and the aging population. These fractures significantly affect patients’ mobility and quality of life. This study evaluates different surgical techniques in patients suffering from FFP to provide standardized recommendations for treatment strategies. In addition, we compared therapeutic concepts and their outcome between two major trauma centers in Germany. MethodsWe conducted a retrospective analysis of 882 patients aged over 65 years who suffered from FFP between 2003 and 2020 at a level I and level III trauma center in a german metropolis. Fractures were classified according to Rommens and Hofmann. Data collection included patient demographics, fracture type, treatment strategy, and length of hospital stay. ResultsFFP I fractures were predominantly treated conservatively at both centers. Significant variability was noted in the treatment of type II and III fractures, with level III trauma center having a higher surgical intervention rate for FFP II in 27.6% compared to the level I trauma center in 9.9% of the cases. The most common procedure at both hospitals was the stabilization of the posterior pelvic ring. Patients who underwent less invasive posterior-only stabilization had shorter length of hospital stay than those who received combined anterior and posterior stabilization. ConclusionsThe study reveals substantial differences in the treatment approaches for FFP between two major trauma centers. Less invasive surgical methods, particularly posterior-only stabilization, are associated with shorter hospital stays and potentially better outcomes for elderly patients with unstable FFP. Clinical RelevanceThis study underscores the importance of minimally invasive surgical techniques in managing FFP in elderly patients, highlighting their potential to reduce the length of hospital stay and improve recovery.

Adolescents’ and young women’s perspectives on participation in biomedical clinical trials for HIV prevention in Tanzania and India: a qualitative inquiry

ABSTRACT Adolescent girls and young women are disproportionately affected by HIV in many lower-resource settings. These individuals are often excluded from early clinical trials for new HIV prevention products, thus delaying potential access. We explored adolescent girls’ and young women’s (AGYW) perceptions of HIV risk, perspectives on trial participation, and understanding of research concepts. Individual or repeated in-depth interviews were conducted with a total of 43 AGYW. Interviews were conducted in participants’ language of choice, audio-recorded, transcribed, and translated into English. Thematic analysis was applied. A total of 21 participants were enrolled from Dar es Salaam, Tanzania, and 22 from Pune, India. HIV risk perception varied by country, with Tanzanian participants often describing risk as behaviors tied to economic factors, and Indian participants describing risk as behaviors associated with limited HIV knowledge, inequitable gender norms, and pervasive sexual violence. Trial participation was largely viewed as acceptable; however, concerns were raised regarding standard recommendations for using condoms and contraception during trial participation, and the potential for side effects. Research concepts were notably challenging for participants to understand, particularly the concept of placebo. Although adult involvement was perceived as useful support in Tanzania, it was deemed essential for trial participation in India. Participants in our study described a need for and potential benefits of new HIV prevention products. Taking into consideration the local context, clinical trials with adolescent girls and young women should ensure understanding of research requirements and concepts, minimize preventive misconceptions, and consider involvement of a trusted adult.

Transforming Cardiovascular Risk Prediction: A Review of Machine Learning and Artificial Intelligence Innovations.

Cardiovascular diseases (CVDs) remain a leading cause of global mortality and morbidity. Traditional risk prediction models, while foundational, often fail to capture the multifaceted nature of risk factors or leverage the expanding pool of healthcare data. Machine learning (ML) and artificial intelligence (AI) approaches represent a paradigm shift in risk prediction, offering dynamic, scalable solutions that integrate diverse data types. This review examines advancements in AI/ML for CVD risk prediction, analyzing their strengths, limitations, and the challenges associated with their clinical integration. Recommendations for standardization, validation, and future research directions are provided to unlock the potential of these technologies in transforming precision cardiovascular medicine.

Assessment of decision-making with locally run and web-based large language models versus human board recommendations in otorhinolaryngology, head and neck surgery.

Tumor boards are a cornerstone of modern cancer treatment. Given their advanced capabilities, the role of Large Language Models (LLMs) in generating tumor board decisions for otorhinolaryngology (ORL) head and neck surgery is gaining increasing attention. However, concerns over data protection and the use of confidential patient information in web-based LLMs have restricted their widespread adoption and hindered the exploration of their full potential. In this first study of its kind we compared standard human multidisciplinary tumor board recommendations (MDT) against a web-based LLM (ChatGPT-4o) and a locally run LLM (Llama 3) addressing data protection concerns. Twenty-five simulated tumor board cases were presented to an MDT composed of specialists from otorhinolaryngology, craniomaxillofacial surgery, medical oncology, radiology, radiation oncology, and pathology. This multidisciplinary team provided a comprehensive analysis of the cases. The same cases were input into ChatGPT-4o and Llama3 using structured prompts, and the concordance between the LLMs' and MDT's recommendations was assessed. Four MDT members evaluated the LLMs' recommendations in terms of medical adequacy (using a six-point Likert scale) and whether the information provided could have influenced the MDT's original recommendations. ChatGPT-4o showed 84% concordance (21 out of 25 cases) and Llama 3 demonstrated 92% concordance (23 out of 25 cases) with the MDT in distinguishing between curative and palliative treatment strategies. In 64% of cases (16/25) ChatGPT-4o and in 60% of cases (15/25) Llama, identified all first-line therapy options considered by the MDT, though with varying priority. ChatGPT-4o presented all the MDT's first-line therapies in 52% of cases (13/25), while Llama 3 offered a homologous treatment strategy in 48% of cases (12/25). Additionally, both models proposed at least one of the MDT's first-line therapies as their top recommendation in 28% of cases (7/25). The ratings for medical adequacy yielded a mean score of 4.7 (IQR: 4-6) for ChatGPT-4o and 4.3 (IQR: 3-5) for Llama 3. In 17% of the assessments (33/200), MDT members indicated that the LLM recommendations could potentially enhance the MDT's decisions. This study demonstrates the capability of both LLMs to provide viable therapeutic recommendations in ORL head and neck surgery. Llama 3, operating locally, bypasses many data protection issues and shows promise as a clinical tool to support MDT decisions. However at present, LLMs should augment rather than replace human decision-making.

Human autonomy with AI in the loop

ABSTRACT In the wake of recent advancements in the field of AI, this paper investigates the impact of recommender systems and generative models on human decisional and creative autonomy. For this purpose, we adopt Dennett’s conception of autonomy as self-control. We show that recommender systems can play a double role in relation to decisional autonomy: as information filter, they can augment self-control in decision-making, but also act as mechanisms of remote control that clamp degrees of freedom. As for generative models in AI, we show that they can be seen as a powerful system of selection and suggestion (similar to standard recommender systems) but also as an instrument for information production. We suggest that the latter perspective opens new possibilities in terms of creative autonomy. Additionally, for both systems we propose a distinction between “extrinsic” and “intrinsic” mechanisms and effects. Through Dennett’s theory of self-control, this paper offers new insights into the relation between AI and human autonomy by framing it in terms of remote or self-control and by addressing the impact of generative models on creative autonomy.

Cardiovascular-Liver-Metabolic Health: Recommendations in Screening, Diagnosis, and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease in Cardiovascular Disease via Modified Delphi Approach.

There is a new awareness of the widespread nature of metabolic dysfunction-associated steatotic liver disease (MASLD) and its connection to cardiovascular disease (CVD). This has catalyzed collaboration between cardiologists, hepatologists, endocrinologists, and the wider multidisciplinary team to address the need for earlier identification of those with MASLD who are at increased risk for CVD. The overlap in the pathophysiologic processes and parallel prevalence of CVD, metabolic syndrome, and MASLD highlight the multisystem consequences of poor cardiovascular-liver-metabolic health. Metabolic dysfunction and associated insulin resistance, together with the predilection for ectopic fat deposition in the liver and surrounding tissues, are associated with elevated risk of endothelial dysfunction, systemic inflammatory response, and ectopic fat deposition in the epicardium. This complex pathophysiology can accelerate atherogenic dyslipidemia, atherogenesis, diastolic dysfunction, valvular calcification, and cardiac arrhythmias. Despite the mounting evidence of mechanistic pathways underpinning MASLD and CVD, current recommendations have not clearly focused upon MASLD as a risk factor or target for intervention in CVD. We have brought together a diverse range of international experts committed to promoting cardiovascular-liver-metabolic health and related outcomes across the globe. The overarching goal of this document is to offer a construct for clinicians in the cardiovascular field with regards to (1) diagnosis and screening of MASLD through the use of noninvasive serum and imaging tests; (2) screening for CVD in all individuals with MASLD regardless of established atherosclerotic risk factors; and (3) the approach to management of MASLD with respect to prevention of CVD through lifestyle, as well as pharmacologic and surgical strategies. To achieve this, the modified Delphi method was applied and a series of evidence-based quality standard recommendations have been identified.

Transformation of Consumer Protection Against Loss of Customer Funds in Digital Banking

Digital banking has become a major trend in the global financial sector, offering ease of access and efficiency for customers. However, this development also brings new risks, particularly related to the loss of funds due to cyber attacks. This research analyzes the legal vacuum in the regulations protecting customers of digital banking in Indonesia, particularly as regulated by POJK No. 12/POJK.03/2021 and POJK No. 13/POJK.03/2021. Despite the existing legal framework, this study identifies the weak legal protection for customers regarding the risk of losing funds due to cyber attacks, as well as the lack of clarity regarding the bank's responsibility in such situations. By examining national and international case studies and providing recommendations for regulatory enhancement and security standards, this study aims to contribute to the ongoing efforts to protect consumers in the increasingly complex context of digital banking.

Influence of available impact energy of the testing machine on drop weight tear test characteristics of high toughness pipeline steels

Abstract. Problem. Currently, the problem he methodological issues related to drop load testing (DLT) of rolled plates and pipes made of highviscosity steel for high-pressure gas mains are considered. The imperfection of the current standards in terms of selecting the values of the stored energy of the copra, ensuring the correct testing of metal of the entire size range, is note. Goal Evaluation of the influence of stored copra energy on the results of WIP in terms of the amount of viscous component and absorbed fracture energy of full-thickness specimens of high-viscosity pipe steels widely used in the construction of high-pressure gas pipelines. Methodology. We examined sheets and base metal of pipes of strength classes X65, X70 and X80 of various thicknesses manufactured using thermomechanical rolling technology. The falling load tests were performed on Zwick copters of different capacities. Results The limits of application of the recommendations of APIRP5L3 and EN10274 standards for the choice of the value of the stored energy of the copra during the falling load test of high-viscosity pipe steels have been clarified. The recommendations are applicable only for steels with a thickness of less than 25 mm. Recommendations for selecting the optimal values of the stored energy of the copra at the HDM of high-viscosity pipe steels with a thickness of 25 mm and more are given Originality. The influence of stored copra energy on the results of WIP of high-viscosity pipe steels is estimated. Practical value. Recommendations were issued on the choice of the value of the stored energy of the ERW copra during testing, which will increase the measurement accuracy and reliability of the assessment of the resistance to destruction of gas pipelines

A prospective study comparing highly qualified Molecular Tumor Boards with AI-powered software as a medical device.

The implementation of cancer precision medicine in Japan is deeply intertwined with insurance reimbursement policies and requires case-by-case reviews by Molecular Tumor Boards (MTBs), which impose considerable operational burdens on healthcare facilities. The extensive preparation and review times required by MTBs hinder their ability to efficiently assess comprehensive genomic profiling (CGP) test results. Despite attempts to optimize MTB operations, significant challenges remain. This study aims to evaluate the effectiveness of QA Commons, an artificial intelligence-driven system designed to improve treatment planning using CGP analysis. QA Commons utilizes a comprehensive knowledge base of drugs, regulatory approvals, and clinical trials linked to genetic biomarkers, thereby enabling the delivery of consistent and standardized treatment recommendations. Initial assessments revealed that the QA Commons' recommendations closely matched the ideal treatment recommendations (consensus annotations), outperforming the average results of MTBs at Cancer Genomic Medicine Core Hospitals. A clinical performance evaluation study will be conducted by comparing the QA Commons' treatment recommendations with those of the Academia Assembly, which includes medical professionals from the Cancer Genomic Medicine Core and Hub Hospitals. One hundred cases selected from the "Registry of the Academia Assembly," based on defined inclusion and exclusion criteria, will be analyzed to assess the concordance of recommendations. The expected outcomes suggest that QA Commons could reduce the workload of MTB members, standardize the quality of MTB discussions, and provide consistent outcomes in repeated patient consultations. In addition, the global expansion of QA Commons could promote worldwide adoption of Japan's pioneering precision oncology system.

Performance evaluation of nine reference centers and comparison of DNA extraction protocols for effective surveillance of Leishmania-infected Phlebotomine sand flies: Basis for technical recommendations.

Leishmaniasis, caused by Leishmania protozoan parasites transmitted by Phlebotomine sand flies, is a significant public health concern in the Mediterranean basin. Effective monitoring of Leishmania-infected sand flies requires standardized tools for comparing their distribution and infection prevalence. Consistent quantitative real-time PCR (qPCR) parameters and efficient DNA extraction protocols are crucial for reliable results over time and across regions. However, the absence of standardized technical recommendations for Leishmania DNA detection hinders effective surveillance. This study aimed to compare different DNA extraction protocols and conduct a qPCR-based External Quality Assessment (EQA) through a multicenter study involving nine reference laboratories, with a focus on optimizing Leishmania DNA detection in sand fly. EQA samples consisted of Leishmania infantum and L. major species, at concentrations ranging from 101 to 104 parasites/mL. All but one center detected all concentrations, demonstrating strong diagnostic proficiency. The ability to detect low concentrations highlighted the robustness of the qPCR assay used, though variations in Cq values indicated differences in sensitivity related to technical capabilities or DNA extraction kit performance. A comparative analysis of seven DNA extraction methods identified the EZ1 DSP Virus Kit and QIAamp DNA mini-kit as the most efficient, supporting their use in standardized protocols. The study also assessed the effects of lyophilization and shipment conditions, showing no significant compromise in Leishmania detection despite slight variations in Cq values. Experimentally infected sand flies were included to simulate field conditions, and all centers successfully detected positive samples with varying Cq values, probably reflecting differences in infection load. This study emphasizes the importance of standardized DNA extraction protocols and continuous quality assurance for accurate Leishmania DNA detection. The results highlight the superior performance of certain extraction kits and the need for ongoing technical training, essential for reliable leishmaniasis surveillance, particularly in field settings with low infection densities.

Evaluation of the efficacy and safety of controlled-release phentermine/topiramate in adults with obesity in Korea: A randomized, double-blind, placebo-controlled, phase 4 trial (QUEEN's study).

This study evaluated the efficacy and safety of a combination of phentermine and delayed-release topiramate (PHEN/TPM CR) versus placebo as an adjunct to standard lifestyle recommendations in Korean adults. This 56-week, randomized, double-blind, placebo-controlled, phase 4 trial enrolled adults (age 19-70 years) with obesity (BMI ≥ 25 kg/m2) at eight sites in South Korea. After a 12-week lifestyle programme, participants were randomly assigned in a 1:1 ratio to receive PHEN/TPM CR or placebo. PHEN/TPM CR was commenced at 3.75 mg/23 mg daily for 14 days and increased to 7.5 mg/46 mg daily, and to 15 mg/92 mg if 3% weight loss was not achieved after 12 weeks. The primary outcomes were percentage change in body weight from baseline to Week 56. A total of 232 participants underwent randomization. At 56 weeks, the percentage change in body weight was -8.3% with PHEN/TPM CR and -2.3% with placebo (treatment difference -6.1%; 95% confidence interval [CI], -7.7 to -4.5, p < 0.001). Participants receiving PHEN/TPM CR were more likely to achieve ≥5% weight loss compared with those receiving placebo (68.5% vs. 25.0%, odds ratio [OR], 6.4; 95% CI, 3.5 to 11.6; p < 0.001). Dizziness, paraesthesia and dry mouth were more common in the PHEN/TPM CR group, although most adverse events were mild or moderate. Administration of PHEN/TPM CR plus lifestyle intervention in Korean adults with obesity resulted in a greater reduction in body weight and adiposity than lifestyle intervention alone.

Curative treatment for oligometastatic gastroesophageal cancer– results of a prospective multicenter study

PurposeOligometastatic gastroesophageal cancer is a clinical entity with no standard treatment recommendation. Treatment with curative intent has recently emerged as an option for selected patients in contrast to the traditional palliative treatment strategy. This prospective study aimed to assess the safety and efficacy of combined systemic and local treatment with curative intent for patients with oligometastatic gastroesophageal cancer.MethodsIn a multicenter study, consecutive patients with gastroesophageal cancer and metastases in the liver and/or extra-regional lymph nodes were screened for inclusion. Eligible patients were offered curatively intended perioperative chemotherapy followed by surgical resection or liver ablation. Primary endpoints were treatment safety and feasibility. Secondary outcomes included postoperative mortality, treatment response, progression-free survival, and overall survival. Subgroup analyses were stratified based on oligometastatic location.ResultsA total of 29 (82.9%) patients completed treatment with surgical resection (93.1%), liver ablation (3.4%), or definitive chemoradiotherapy (3.4%). Postoperative complications were found in 19 (73.1%) patients, whereas postoperative mortality was 0%. The most common complications included infection (34.6%) and respiratory complications (34.6%). Median overall survival was 20.9 months (interquartile range 11.2–42.6) from diagnosis and 17.0 months (interquartile range 6.4–35.9) from surgery in patients who were treated with neoadjuvant chemotherapy followed by surgery. Median progression-free survival was 5.8 months (interquartile range 3.1–11.3).ConclusionThis study found curative treatment to be a relatively safe option, with an overall survival of 20.8 months and no postoperative mortality.

The Value of Bone Marrow Assessment by FDG PET/CT, Biopsy and Aspirate in the Upfront Evaluation of Mantle Cell Lymphoma: A Nationwide Cohort Study.

Assessment of bone marrow infiltration (BMI) is part of the initial staging of mantle cell lymphoma (MCL), although BMI evaluated by biopsy (BMB) is not considered significant in the MIPI scales, and standardized recommendations remain lacking. To evaluate the accuracy and prognostic impact of BMI assessed by PET/CT and BMB in a large series of MCL patients. We deconstructed the IPI-NCCN, MIPI, and MIPI-c indices and considered BMI as positive if indicated by a BMB, PET/CT scan, or a combination of both. In the total cohort (n = 148), 110 patients had BMI detected by BMB and 33 by PET/CT. The sensitivity of BMB was higher than that of PET/CT (94.8% vs. 28.4%), as were its negative predictive value (84.2% vs. 27.8%) and accuracy (95.9% vs. 43.9%). In the total cohort, BMI detected by PET/CT showed a significant predictive value for PFS (p = 0.027), while BMB demonstrated independent prognostic value only in combination with PET/CT (p = 0.025). Among intensively treated patients (n = 128), PET/CT had significant clinical impact on PFS (p = 0.030), and when combined with BMB, it provided independent prognostic value for both PFS and OS (p = 0.026 and p = 0.033, respectively). Based on these findings, we propose a prognostic model (MCL-PET-I) that incorporates BMI by PET/CT, allowing for the identification of three groups with distinct clinical outcomes (p < 0.0001 for PFS and p = 0.00025 for OS). In the upfront work of MCL, PET/CT-based BMI has greater prognostic impact, while BMB remains essential for staging. We propose the MCL-PET-I prognostic index, which effectively differentiates between clinical risk groups.

Ventilator circuits mechanics and ventilator compensation

Introduction Invasive mechanical ventilation usually uses a double limb circuit. However, those circuits are not standardized and usually come from different manufacturers with different lengths, diameters, compliances and resistances. Those differences can affect the delivered tidal volumes and pressures delivered to the patient. We aimed to test three different circuits to measure their compliance and resistance and measure their effects on delivered tidal volume and airway pressures after being calibrated by the ventilator. Methods Descriptive study, three different double limb circuits: separate inspiratory and expiratory limb (Vyaire 72 inch length, 22 mm diameter), separate inspiratory with heated wire and expiratory limb (Fisher and Paykel 71 inch, 22 mm diameter), and separate inspiratory and expiratory limb in one tube (Vyaire length 75 inch and 22 mm diameter). Bellavista 1000e ventilator (Zoll, MA, USA) was used to conduct the experiment with the volume controlled mode, tidal volume 500 ml, inspiratory flow of 30 L/min, PEEP of 5 cmH2O, respiratory rate of 20 bpm. Leak, resistance and compliance obtained from the ventilator display during circuit calibration. A passive single lung model with compliance of 80 ml/cmH2O and resistance of 10 cmH2O/L/s constructed using lung simulator (ASL 5000) used to measure the delivered the tidal volume, flow, airway pressures (Peak, plateau, PEEP) delivered to calculate the total compliance and resistance and the effect of the circuits. Results The three circuits had different compliances and resistances. Separate limbs: compliance of 0.84 ml/cmH2O, Inspiratory resistance 3.37 cmH2O/L/s, expiratory resistance 5.54 cmH2O/L/s resulting in total compliance 84.06 ml/cmH2O, inspiratory resistance 4.8 cmH2O/L/s. Separate limbs with heated wire in inspiratory limb: compliance 1.88 ml/cmH2O, Inspiratory resistance 3.22 and expiratory resistance 4.67 cmH2O/L/s, resulting in total compliance 82.74 ml/cmH2O, inspiratory resistance 4.81 cmH2O/L/s. Double limb in one circuit: compliance 2.25 ml/cmH2O, Inspiratory resistance 4.07 cmH2O/L/s, expiratory resistance 4.38 cmH2O/L/s, resulting in total compliance 82.91 ml/cmH2O, inspiratory resistance 4.81 cmH2O/L/s. Conclusion The measured compliances and resistances of the circuits differed slightly, however the ventilator compensated well for the differences with minimal difference in the combined total compliances and resistances. Further investigation across a broader range of circuit designs and ventilator models could help establish more standardized guidelines and recommendations for circuit selection in clinical practice. Keywords: Ventilator circuits, circuit compliance and resistance, ventilator compensation

Moral distress, professional value, and vocational choice among senior nursing students: A cross-sectional study.

During clinical placement, nursing students may experience unease and moral distress, which negatively impacts their professional values and vocational choices. However, no instrument exists to measure moral distress in nursing students. Thus, this study constructs measurement items for moral distress and explores the factors that influence the vocational choices of nursing students. The participants were recruited from three universities in South Korea Between September and October 2021. This study was adopted with a convenience sample of 270 Korean fourth-year nursing students who completed their clinical practice at tertiary general hospitals in three provinces in the North, Middle, and South areas of South Korea. Data were collected through a self-administered structured questionnaire. The study developed the items and subscales of the Moral Distress Scale using multistep methods following the recommendations of the Consensus-Based Standards for the Selection of Health Status Measurement Instrument. The study constructed 22 items of the three factors of Moral Distress Scale. The three factors of the Moral Distress Scale were "moral distress by low quality of care," "moral distress by a heavy workload and an insufficient workforce," and "unfair and distrust." The factors influencing the vocational choice of the nursing students were high professional values, intention not to choose nursing as a future career, lacking vision for choosing nursing, democratic family climate, and having at least one parent who was a medical professional. Moral distress in undergraduate nursing students may not influence their intention to choose the nursing profession. Fostering the professionalism and professional values of nursing students through university education curricula may help maintain their professional identity.

The Circadian Rhythm of Intracellular Protoporphyrin IX Accumulation Through Heme Synthesis Pathway in Bladder Urothelial Cancer Cells Exposed to 5-Aminolevulinic Acid.

Background/Objectives: The standard recommendation for patients with non-muscle invasive bladder cancer is 5-aminolevulinic acid-mediated photodynamic diagnosis. The intensity of the fluorescence caused by the intracellular accumulation of protoporphyrin IX (PPIX) varies among tumors and patients. This study investigated the circadian rhythm of intracellular PPIX accumulation in bladder urothelial cancer cells exposed to 5-aminolevulinic acid. Methods: The expression of two clock genes, PER2 and BMAL1, and their impact on intracellular PPIX accumulation were evaluated in two bladder cancer cell lines, UM-UC-3 and J82, and mouse xenograft models. We evaluated the enzymes involved in the heme synthesis pathway that potentially affect the circadian rhythm of intracellular PPIX accumulation. The red fluorescence intensity of the images captured during photodynamic diagnosis-assisted transurethral resection of bladder tumors was quantified and compared among the four groups according to surgery start time: 9 a.m.-11 a.m., 11 a.m.-1 p.m., 1-3 p.m., and 3-5 p.m. Results: We observed the circadian rhythm of intracellular PPIX accumulation, which was potentially regulated by the clock genes PER2 and BMAL1. Two enzymes involved in the heme synthesis pathway, coproporphyrinogen oxidase and ferrochelatase, exhibit a circadian rhythm. The fluorescence intensity started gradually increasing at 12 p.m., and the highest level was observed in patients who underwent surgery between 3 and 5 p.m. Conclusions: Our findings suggest that it may be possible to optimize the timing of the photodynamic diagnosis in photodynamic diagnosis-assisted transurethral resection of bladder cancer based on the circadian rhythm to improve tumor detection and treatment outcomes.

ESSD-ESGAR best practice position statements on the technical performance of videofluoroscopic swallowing studies in adult patients with swallowing disorders.

Videofluoroscopic swallowing studies (VFSS) remain the gold standard for the instrumental assessment of oropharyngeal swallowing disorders alongside flexible endoscopic evaluation of swallowing (FEES), requiring a high standard of quality and correct implementation. The current best practice position statements aim to guide the clinical practice of VFSS in individuals experiencing swallowing disorders. An international expert consensus panel with expertise in oropharyngeal dysphagia, comprised of radiologists, speech-language therapists, otolaryngologists, and other professionals in the field, convened by the European Society of Swallowing Disorders (ESSD) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), developed best practice position statements. They were established using an online Delphi methodology involving an online panel discussion and item preparation and three consecutive rounds. Consensus was reached when ≥ 80% of the participants agreed on a specific recommendation. Eighteen best practice position statements were formulated, thereby establishing standard recommendations on the technical performance of VFSS. They cover VFSS planning, correct implementation, documentation, radiation protection, equipment and maintenance, and education and training. These position statements summarise the panel's deliberations and recommendations in performing VFSS, representing the agreed consensus of experts from ESSD and ESGAR. They provide a structured framework for optimising and standardising the performance of VFSS in patients with swallowing disorders. Question Significant regional and national differences in clinical practice when performing VFSS highlight the need for interdisciplinary recommendations to optimise patient care. Findings Eighteen statements were developed by representatives of the ESSD and the ESGAR. Clinical relevance These best practice position statements on the technical performance of VFSS may serve as a basis for standardising the procedure and ensuring high-quality service.

European standard clinical practice recommendations for paediatric high-grade gliomas

European standard clinical practice recommendations for paediatric high-grade gliomas

Evaluation of Risk Factors for Dupilumab-Associated Ocular Sequelae in the Treatment of Atopic Dermatitis.

Dupilumab is a monoclonal antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13) signaling and is used in the treatment of moderate-to-severe atopic dermatitis (AD) in those six months or older who are uncontrolled on or cannot tolerate topical treatments. Ocular surface disease is a recognized adverse effect of dupilumab, yet few studies describe the risk factors for developing ocular adverse effects.There are no standardized recommendations for monitoring patients on this medication. This study aims to highlight the risk factors associated with the development of dupilumab-associated ocular surface disease (DAOSD) described in the literature. The PubMed and ScienceDirect databases were searched in April 2024 using key search terms. Nine articles were included after deduplication, title/abstract screening, full-text review, and quality appraisal. Studies were included if they were written in English and discussed risk factors for the ocular side effects of dupilumab. Studies were excluded if they discussed other biological agents or ocular conditions of other origins. Out of the nine studies analyzed, six described prior history of ocular disease as a risk factor for developing DAOSD. Severe AD was highlighted as a risk factor in five out of nine studies. Elevated total immunoglobulin E (IgE) levels and eosinophil count were described as risk factors in four out of nine studies. Three studies cited facial or eyelid eczema, and two studies highlighted family history of atopy as having an association with the development of DAOSD. One study described high levels of chemokines, as well as the personal history of other atopic conditions, as independent risk factors.While the etiology of DAOSD is not fully understood, past studies have elucidated potential risk factors for its development. Those being treated with dupilumab for AD have higher severity or refractory disease, and the discontinuation of treatment due to ocular side effects may have implications on the quality of life for these patients. Additional studies are needed to better understand the risk factors for DAOSD and prevent further complications.

Clinical Practice Guidelines for Adult Vascular Access: The Protocol for the Association for Vascular Access Clinical Practice Guidelines Systematic Review

Abstract The Institute of Medicine (IOM) defines clinical practice guidelines (CPGs) as “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Creating clinical practice guidelines involves a systematic process that ensures the development of evidence-based and reliable recommendations for health care professionals. The Association for Vascular Access’ CPGs are being developed by a diverse multidisciplinary team to provide evidence-based recommendations and guidance for health care professionals involved directly and indirectly in vascular access administration, leadership, device insertion, and care. This protocol outlines the process implemented to develop CPGs to ensure the reader trusts in the accuracy. The AVA CPG protocol presents a comprehensive and evidence-based approach to vascular access care. By providing standardized recommendations, it aims to improve patient outcomes, reduce complications, and enhance the delivery of high-quality care. The protocol serves as a valuable resource for health care professionals involved in vascular access management, facilitating best practices and promoting standardized approaches to enhance patient safety and quality of care.