The aim of this study was to explore the experiences of people with Vertebral Fragility Fracture (VFF) due to osteoporosis and the impact of the physical changes resulting from their condition.

Interpretive qualitative research using semi-structured individual interviews PARTICIPANTS: Eighteen people with VFF were interviewed; nine men and nine women. Participants ranged in age from 55 to 92 years and had between 1 and 10 previous vertebral fragility fractures.

Interviews were offered in participants own homes, at the hospital or by Microsoft TEAMS or telephone. These were audio-recorded, transcribed verbatim, and analysed through reflexive thematic analysis.

Results are presented within four themes: loss of height; finding spinal curvature upsetting, the impact on looking good and whether having a stoop was inevitable or could be prevented by active engagement.

The findings show the negative impact on self-image caused by the physical manifestations of a VFF and that these can be as significant and distressing as pain and functional limitations. This information is useful for physiotherapists treating people with vertebral fragility fractures offering insight into the patients' experiences of these physical changes. CONTRIBUTION OF THE PAPER.

The Netherlands faces 60% prevalence of chronic conditions by 2040, impacting societal participation and quality of life. Current clinical care inadequately addresses these consequences, and most hospitals do not integrate occupational health in their care.

To develop a generic person- and work-oriented medical care model (WMCM) based on real life experiences with work-oriented care and supporting the chronically ill in active societal participation.

A qualitative research project with a participative approach in one hospital (November 2019 until March 2020). In an expert meeting, a schematic representation of a work-oriented care model was developed. Subsequent discussion rounds, with professionals from different patient groups, iteratively refined the model to a WMCM.

Consensus was reached after seven rounds of discussion, defining the model's core elements (1) a combination of biomedical and biopsychosocial approaches, (2) involvement of a clinical occupational physician in the treatment team, (3) a coordinating role for nursing specialists, and (4) incorporation of a work-oriented intervention plan (WoIP) into the treatment plan. Advocating early attention to societal participation, the model emphasises the WoIP and consensus on monitoring indicators. The final goal is a sustainable return to societal participation, considering both quality of life and work.

It is feasible to develop a generic person- and work-oriented care model for patients with chronic illness within a hospital care setting. Collaboration between healthcare professionals and a specialised occupational physician, with a central role for nurses, is deemed crucial.

Alternative therapeutic strategies for herpes zoster, especially for acute phase pain relief, are still largely unexplored. This study aimed to compare the effects of wrist-ankle acupuncture combined with standard pharmacological treatment versus standard pharmacological treatment alone in relieving pain in the acute phase of herpes zoster. An open-label, randomized, controlled clinical trial was conducted, enrolling patients diagnosed with acute-phase herpes zoster with pain visual analog scale (VAS) scores greater than or equal to 2. The participants were randomly assigned to either the control group receiving standard pharmacological treatment (antiviral therapy combined with pain relievers) alone or the experimental group receiving wrist-ankle acupuncture plus standard pharmacological treatment. VAS pain scores were recorded on days 1-7 and on day 28 after treatment began. Dermatology Life Quality Index scores were assessed both during the pre-treatment phase and at hospital discharge. A total of 106 patients completed the trial protocol and were included in the analysis, with 52 and 54 patients in the control and experimental groups, respectively. The clinical cure rates of pain (the rate of complete absence of pain) in the experimental group was statistically higher than control group on days 7 after treatment began(87.04% vs 65.38%, p < 0.005). The average pain VAS scores of the experimental group were lower than the control group on days 2-6 after treatment began, and they are statistically significant (all p < 0.05). No significant difference was observed between day 7 and day 28 after treatment began (p > 0.05). The Dermatology Life Quality Index scores significantly differed at hospital discharge (p < 0.05). Side effects did not significantly differ between the two groups (all p > 0.05). Wrist-ankle acupuncture combined with standard pharmacological treatment may potentially improve the pain cure rate at 7 days post-treatment. This suggests a potential new strategy for alleviating pain in patients in the acute phase of herpes zoster. Trial registration: ChiCTR2300071795.

Head and neck cancer (HNC) survivors may face several challenges when returning to work. Although there are some qualitative studies on the return-to-work experiences of HNC survivors, a comprehensive review of these studies is lacking. This study aimed to systematically evaluate the emotions, experiences, and needs of HNC survivors returning to work.

This review was conducted in accordance with the PRISMA statement of systematic reviews. Databases including PubMed, Embase, Web of Science, MEDLINE, Cochrane Library, CINAHL, and APA PsycInfo were searched from inception to December 2023 to identify qualitative studies on the emotions and experiences of HNC survivors returning to work. The quality of the included studies was independently assessed by two investigators using the Joanna Briggs Institute Critical Appraisal Tool for Qualitative Research (2016).

Eleven studies were included in this review. A total of 54 key findings were extracted and synthesized into three overarching themes and 10 subthemes: stress perception, regulatory mechanisms, and external support.

HNC survivors faced many challenges in returning to work, including symptomatic burden and psychological challenges. Efforts should focus on enhancing symptom management, addressing psychological well-being, and strengthening social support systems. Additionally, targeted interventions and support strategies should be developed to facilitate the timely reintegration of HNC survivors into the workplace.

We commend Knoedler et al. for their comprehensive study, "The impact of body mass index on breast reduction outcomes," which leverages a robust sample size and a reputable dataset to address an important topic in plastic surgery. While the study successfully highlights the relevance of BMI in breast reduction outcomes, we identify several methodological limitations that could affect the generalizability and depth of its findings. Crucially, the omission of confounding variables such as smoking, diabetes, immunologic and mental health status may limit the accuracy of the reported outcomes. Unlike previous work by the same authors on gynecomastia surgery, which incorporated more comprehensive factors, this study does not fully explore the relationship between BMI, reoperation, and complication rates. Moreover, the limited 30-day post-operative follow-up may overlook long-term complications such as fat necrosis and scarring, which are critical to patient satisfaction. The exclusion of male, non-binary patients, and those undergoing simultaneous procedures, while controlling variability, restricts the study's applicability to broader populations. Additionally, reliance on NSQIP, though valuable, omits nuances like surgical techniques and patient compliance. We suggest future studies incorporate a broader range of variables and follow-up periods to enhance the scope and precision of surgical outcome research.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The aim of this study is to overcome the challenges of poor tumor penetration and systemic toxicity in targeted alpha therapy (TAT) while also evaluating its immunomodulatory effects to enhance antitumor immune responses in melanoma treatment.

This study developed a 211At-labeled single-domain antibody agent ([211At]At-AuNP-ABDMPL16) targeting PD-L1, a protein overexpressed in melanoma cells. The binding affinity and internalization of [211At]At-AuNP-ABDMPL16 were evaluated in vitro using melanoma cell lines. In vivo studies in melanoma-bearing mice were conducted to assess biodistribution, pharmacokinetics, therapeutic efficacy, and the immune response induced by the treatment.

[211At]At-AuNP-ABDMPL16 demonstrated high binding affinity and efficient internalization in melanoma cells, resulting in significant tumor cell death through α-particle radiation. In vivo, [211At]At-AuNP-ABDMPL16 preferentially accumulated in tumors, inhibited tumor growth, and prolonged survival in melanoma-bearing mice. The treatment also triggered a robust anti-tumor immune response, marked by increased cytotoxic T lymphocytes and reduced regulatory T cells within the tumor microenvironment, with minimal systemic toxicity.

[211At]At-AuNP-ABDMPL16 shows promise as a novel therapeutic for melanoma, combining effective tumor targeting with potent cytotoxic and immune-activating effects. These findings support further investigation of this 211At-labeled single-domain antibodies in clinical applications.

The experiences of social and community mental health (SCMH) workers serving in rural communities during the COVID-19 pandemic are understudied. Therefore, nine SCMH workers were interviewed about challenges and strategies for providing mental health services in rural communities in the wake of COVID-19. Through qualitative analyses three primary themes emerged; challenges, needed resources and strategies for addressing mental health needs. Challenges included lack of resources, stigma, and policy barriers, but collaborating with local organizations, providing individualized services, and improving communication were suggested strategies to overcome challenges. The resilience and flexibility of SCMH workers was advantageous in adapting to the changing mental health landscape post-COVID-19, yet advocacy for funding, resources, and training for practitioners in rural mental health is still needed. Findings suggest offering individualized services, forging community connections and maximizing use of existing resources through local collaborations. Moreover, utilizing online mental health services and peer community-building may improve effective services.

Traditional orthodontic treatment methods are associated with long treatment durations and patient discomfort. The mini-implant assisted micro-osteoperforation (MOP) has shown great potential in clinical practice, but systematic research on this technology remains limited.

A retrospective analysis of 106 adult patients requiring extraction of both maxillary first premolars were conducted, with patients randomly grouped: experimental group (EG, mini-implant assisted MOP) and control group (CG, conventional orthodontic treatment), with 53 cases in each. Tooth movement distances, root resorption amounts, craniofacial relationship measurement angles (SNA, SNB, ANB), maxillary anterior tooth positions and angles (U1-X, U1-Y, U1-SN), maxillary first molar positions and angles (U6-X, U6-Y, U6-X), and soft tissue angles (NLA) were compared.

The distance of canine movement in the EG was (1.89±0.28) mm after 1 month of force application, and (3.67±0.54) mm after 2 months of force application. In the CG, the distance of canine movement was (0.96±0.32) mm after 1 month of force application, and (1.88±0.34) mm after 2 months of force application. The EG suggested visibly greater canine movement distances one month and two months after force application as against the CG, with visibly lower U1-X and U1-Y angles, and visibly lower U6-X and U6-Y angles (P<0.05). No visible distinctions were noted in soft tissue angles between the EG and the CG one month and two months after force application (P>0.05).

Compared to existing orthodontic treatment methods, implant-supported mini-screw perforation surgery, as an auxiliary approach to accelerate orthodontic treatment, can significantly accelerate tooth movement without significantly increasing the risk of root resorption, and has minimal impact on craniofacial relationships and soft tissues. This finding provides a new and effective adjunct for orthodontic treatment, with the potential to shorten treatment duration and improve the patient experience in clinical practice, making it of significant importance for advancing the development of orthodontic techniques.

Compliance or adherence with positive airway pressure (PAP) therapy is a major issue in obstructive sleep apnea (OSA). The telemonitoring gives an opportunity to track a group of patients on cloud-based devices. In this study, we followed up patients with this cloud-based method for more than a year and followed up two different cohorts who are on continuous PAP (CPAP) and auto adjusting PAP (APAP) devices. The main objective was to judge whether one device scores over the other.

This was a retrospective study. We included 60 patients in the CPAP group and 80 patients in the APAP group in the study who are using the device for 1 year or more; they all were on cloud-based devices, and for them, we had data of completed 1 year at least. The data were reviewed periodically for compliance, AHI (Apnea-Hypopnea Index), and leak and compared.

Both the groups were matched in terms of age, BMI, and AHI. Adherence at 365 days was significantly more (P < 0.001) for CPAP than APAP. Overall adherence was not lesser than 60% for CPAP in any patient. The mean AHI was 1.48 in CPAP group and 2.30 in APAP group. When we measured the leak in CPAP versus APAP group, it was 0.53 liter/minute more in CPAP group than in APAP group, but it was statistically non-significant (P = 0.8553). The mean pressure level between APAP and CPAP was 11.11 cmH2O in CPAP group and 11.62 cm H2O in APAP group, and it was again statistically non-significant (P = 0.1960). CPAP group used the machine 5.77 hours average, while APAP group used it for 4.51 hours average.

CPAP adherence at 1 year was better over APAP in this study, which has a large cost implication.

Cesarean delivery rates in the United States far exceed the World Health Organization (WHO)'s recommended population cesarean rate of 15%. This has resulted in calls from experts to reduce cesarean delivery rates. However, crude cesarean delivery rates are not necessarily comparable across populations since different birthing populations have different distributions of underlying cesarean delivery risk factors. WHO recommends using the Robson classification system to compare standardized cesarean delivery rates across populations, though it has been rarely used within the U.S.

The objectives of this study were to understand the distribution of cesarean deliveries using the Robson Classification system and to identify associated conditions (and potential drivers) of cesarean delivery across Robson groups.

Our data comes from the Pregnancy and Early Life Longitudinal Data System from the Massachusetts Department of Health, which contains all birth certificate records for Massachusetts from 2011 to 2018. Using the WHO Robson Classification System Implementation guide, we categorized births into one of its 10 categories based on data from birth certificate records and ICD-9 and ICD-10 codes from billing records. Using the linked birth certificate records and hospital discharge records we went beyond the Robson classifications and examined patterns in maternal comorbidities and labor and delivery complications of cesarean deliveries across Robson groups.

Among the 25% of birthing people who had singleton, term, vertex births with spontaneous labor, the cesarean delivery rate was 15% for nulliparous and 3% for multiparous (with no prior cesarean). The prevalence of maternal risk factors was 28% in the former and 30% in the latter. Labor and delivery complications were present in 46% and 35% of births, respectively. Birthing people with breech or transverse fetal presentation had the highest cesarean delivery rates around 95%. Multiparous birthing people with a prior cesarean delivery and cephalic, singleton, term births were the largest contributor to the cesarean delivery rate (38% of all cesareans). Almost all births for malpresentation or malposition of fetus had at least one labor and delivery complication but much lower rates of risk factors (between 25% and 46%).

While cesarean delivery rates, maternal risk factors, and labor and delivery complications followed similar patterns across Robson groups, there were notable discrepancies, especially in births with noncephalic presentations where maternal comorbidity rates matched lower cesarean-risk groups like the nulliparous single-term cephalic births.

The management of inflammatory bowel disease (IBD) in children and adolescents is challenging. Clear evidence-based guidelines are required for this population. This article provides recommendations for managing IBD in Saudi children and adolescents aged 6-19 years, developed by the Saudi Ministry of Health in collaboration with the Saudi Society of Clinical Pharmacy and the Saudi Gastroenterology Association. All 57 guideline statements are based on the most up-to-date information for the diagnosis and management of pediatric IBD.

This randomized, multicenter clinical trial evaluates laparoscopic bilateral inguinal hernia repair outcomes by comparing the Progrip self-fixating mesh to the ProFlor 3D dynamic regenerative scaffold.

Adults aged 18-85 years with clinically diagnosed bilateral primary inguinal hernias were enrolled and randomized into two treatment groups (Progrip or ProFlor) using block randomization. Operative time, intra- and postoperative complications, recurrence rates, postoperative pain, and quality of life were assessed over a 24-month follow-up. The allocation was not blinded to investigators or patients.

From January 2021 to June 2022, 150 patients underwent laparoscopic TAPP repair. Eighteen were lost to follow-up (5 in the ProFlor group, 13 in the Progrip group). A total of 132 patients (67 ProFlor, 65 Progrip) were analyzed. The ProFlor group demonstrated shorter operative times, fewer intra- and postoperative complications, and reduced early postoperative pain compared to the Progrip group. Patients in the ProFlor arm achieved faster recovery and earlier return to daily activities. Notably, none of the ProFlor patients experienced chronic pain, whereas 10.8% of Progrip patients developed this complication. Hernia recurrence was observed in 2 Progrip patients, while no recurrences were reported in the ProFlor™ group.

In this randomized trial, both devices proved feasible and effective for laparoscopic repair of bilateral inguinal hernias. However, the ProFlor scaffold was associated with reduced postoperative pain, absence of chronic pain, and no recurrences during follow-up compared to Progrip. While these findings are encouraging, further studies with larger cohorts and longer-term follow-up are warranted to confirm the potential benefits of the ProFlor scaffold and its role in routine clinical practice.

This study was registered at ClinicalTrials.gov with number NCT06556498.

This umbrella review aims to summarize the major benefits of hearing aid usage in adults by synthesizing findings from published review articles.

A comprehensive search of databases, including MEDLINE, EMBASE, PsycINFO, and Google Scholar, was conducted. The search was limited to English-language review articles published between 1990 and 2023, focusing on hearing aid outcomes in at least 5 adults (aged ≥18 years). Two researchers independently screened titles, abstracts, and full-text articles, and conducted a quality assessment using the Joanna Briggs Checklist for Systematic Reviews and Research Syntheses. A third researcher was involved in discussions with the 2 researchers to resolve conflicts during the screening and quality assessment stages.

Eleven articles were included in this review. There were three systematic reviews with meta-analysis and eight systematic reviews without meta-analysis. The quality assessment indicated that articles scored between 6 and 11 out of a total of 11 criteria. Three articles met all quality criteria. Study participants tended to be middle-aged (≥40 years) or older adults (≥65 years). Participant gender was less clear as this was not consistently reported but appeared to favor men. This umbrella review found that speech perception, communication function, hearing handicap, and self-assessed hearing aid benefit were consistently positively associated with hearing aid use in the analysis of included studies. Hearing handicap was the most frequently reported outcome with evidence from four different studies supporting its mitigation with hearing aid use. There was insufficient evidence in terms of benefit on balance, cognitive function, depression, tinnitus, loneliness, and social isolation. There was conflicting evidence on the impact of hearing aid use on quality of life. Among eligible studies, there were no reports of negative impacts of hearing aid use.

There are a number of potential benefits associated with hearing aid use. However, this review found that there was a clear lack of high-quality evidence and limited use of robust study design to support the benefits of hearing aids on other outcomes such as quality of life and cognition. Inconsistent use and interpretation of various outcome measures makes it difficult to produce homogenous data which is needed to make more conclusive statements about the benefits of hearing aids.

BackgroundChronic low back pain can severely affect quality of life. While several treatments are available, the combination of therapies often results in better outcomes.ObjectiveThis study delves into the comparative effectiveness of combining monopolar dielectric diathermy radiofrequency (MDR) with supervised therapeutic exercise against the latter treatment alone.MethodsA randomized single-blind controlled trial was conducted. The intervention group (( n = 30 ) 30) received MDR with supervised therapeutic exercises for eight weekly sessions for four weeks. The control group (n = 30) received only the same exercise protocol. The following self-report measures were assessed before the first treatment session, at four, and 12 weeks: disability, pain, kinesiophobia, quality of life, sleep quality, emotional distress, isometric trunk strength, and trunk flexion range.ResultsRepeated ANOVA measures revealed significant time*group interactions for the McQuade test (p = 0.003), the physical role (p = 0.011), vitality (p = 0.023), social function (p = 0.006), and mental health subscales (p = 0.042). Between-group analyses showed significant differences for all outcomes at each follow-up: RMDQ (post-treatment, p = 0.040), ODI (post-treatment and 12-week, p = 0.040), VAS (p < 0.001), TSK (p < 0.001), and McQuade Test (p < 0.020).ConclusionThe combination of diathermy radiofrequency with supervised therapeutic exercise significantly surpasses the efficacy of supervised therapeutic exercise alone, showcasing improvements in pain, disability, kinesiophobia, lumbar mobility in flexion, and overal quality of life in patients with chronic low back pain.

This umbrella review aimed to synthesize evidence from systematic reviews of clinical trials on the efficacy of tranexamic acid in gynecology and obstetrics procedures.

We searched Medline, Embase, SciELO and Cochrane Database of Systematic Reviews on March 11, 2024, using the term "tranexamic acid". Four reviewers independently select studies and extract data. We assessed the quality of systematic review and the quality of evidence, using AMSTAR 2 and GRADE tools, respectively.

Of 651 systematic reviews identified, 16 reviews with 96663 patients were included. The surgical procedures were cesarean section, myomectomy, hysterectomy, and cervical intraepithelial neoplasia surgery. All reviews showed a statistically significant and clinically relevant reduction in intraoperative and post-procedure blood loss, associated with intravenous or topical use of tranexamic acid. Tranexamic acid resulted in a significant reduction in the need for blood transfusions and a less pronounced drop in postoperative hematocrit and hemoglobin levels in cesarean section. Several reviews addressed the same question, but the number of included trials varied substantially, which might indicate flaws in search and selection of studies of these reviews. The quality of systematic reviews was low or critically low, and the quality of evidence was moderate.

This umbrella review shows that tranexamic acid can reduce blood loss and hemorrhage in gynecology and obstetrics procedures. High quality systematic reviews are still needed.

Individuals with long-term physical health conditions (LTCs) experience higher rates of depression and anxiety. Conventional self-report measures do not distinguish distress related to LTCs from primary mental health disorders. This difference is important as treatment protocols differ. We developed a transdiagnostic self-report measure of illness-related distress, applicable across LTCs.

The new Illness-Related Distress (IRD) scale was developed through thematic coding of interviews, systematic literature search, think-aloud interviews with patients and healthcare providers, and expert-consensus meetings. An internet sample (n = 1,398) of UK-based individuals with LTCs completed the IRD scale for psychometric analysis. We randomly split the sample (1:1) to conduct: (1) an exploratory factor analysis (EFA; n = 698) for item reduction, and (2) iterative confirmatory factor analysis (CFA; n = 700) and exploratory structural equation modeling (ESEM). Here, further item reduction took place to generate a final version. Measurement invariance, internal consistency, convergent, test-retest reliability, and clinical cut-points were assessed.

EFA suggested a 2-factor structure for the IRD scale, subsequently confirmed by iteratively comparing unidimensional, lower order, and bifactor CFAs and ESEMs. A lower-order correlated 2-factor CFA model (two 7-item subscales: intrapersonal distress and interpersonal distress) was favored and was structurally invariant for gender. Subscales demonstrated excellent internal consistency, very good test-retest reliability, and good convergent validity. Clinical cut points were identified (intrapersonal = 15, interpersonal = 12).

The IRD scale is the first measure that captures transdiagnostic distress. It may aid assessment within clinical practice and research related to psychological adjustment and distress in LTCs.

The medical and public health communities are divided around the use of benzodiazepine ("benzo") pharmacotherapy for anxiety disorders. Recent years have seen increased attention to benzo overprescription and its risks, leading to a pervasive emphasis on deprescribing. Some have resisted this trend, arguing that the balance of evidence supports the safety and efficacy of benzo pharmacotherapy for both short-term and long-term treatment of anxiety disorders. Given that rising rates of anxiety disorders and benzo misuse are both serious public health concerns, there is an urgent need for comprehensive evidence-based best practices for the prescription of benzos for anxiety. At present, however, major scientific gaps make it impossible to formulate such guidance. Most concerning is the lack of research into as-needed and intermittent prescription and use, which are both what benzos are best suited for, and likely, how they are most commonly administered. Further research into the safety and efficacy of both long-term daily and intermittent, as-needed benzo prescription and use are badly needed. But a roundly "anti-benzo" sentiment may be causing problematic underprescription of benzos, particularly when superior alternatives like cognitive-behavioral therapy are not widely available.

Parental psychosis has been reliably associated with adverse outcomes for both parents and children. Despite this, support for these families remains limited. Understanding the everyday parenting practices of parents with psychosis, and whether they differ from parents without psychosis is crucial for developing suitable, evidence-based interventions. We therefore aimed to synthesise quantitative and qualitative research to answer two research questions: (1) 'What are the parenting practices of parents who experience psychosis?' and (2) 'Are the parenting practices of parents who experience psychosis the same as the parenting practices of parents without serious mental illness (SMI)?' Five databases were searched for terms associated with parenting, psychosis and parenting practices, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The Mixed Methods Appraisal Tool was used for quality appraisal prior to an integrative narrative synthesis being conducted. Twelve studies (n = 9 quantitative; n = 3 qualitative) containing 1115 parents with psychosis were included. The synthesis revealed that parents with psychosis frequently use positive authoritative parenting strategies, but sometimes this can be difficult to sustain, with parents resorting to permissive and inconsistent parenting practices. They appear to do so more frequently than parents without SMI but because only four studies utilised a control group, more comparative research is needed. The review recommends further support, and use of parenting interventions for parents with psychosis, alongside systemic practice change initiatives within adult mental health services.

The proposed technique utilizes the osteoconductive regenerative properties of bone-substitute materials (BSMs) and the space-maintaining function of titanium mesh to restore the alveolar ridge at extraction sites with lost labial plates in a single procedure. This approach may reduce the need for extensive ridge augmentation procedures, shorten treatment duration, minimize complications, and potentially lower overall costs for patients.

Both patients presented with hopeless dentition, characterized by chronic infection and loss of the labial plates. To regenerate the alveolar ridge, a titanium mesh was utilized in combination with a layered application of xenograft and allograft BSMs. The success of this technique depended on mesh stabilization, thorough site debridement, and the absence of soft-tissue tension.

The technique effectively restored the lost labial plates and regenerated sufficient bone to accommodate dental implants. Significant bone regeneration was achieved in both cases, with minimal complications. In one case, a minor mesh exposure occurred; however, it did not affect the healing and was managed during the re-entry surgery.

The presented technique effectively regenerated the lost labial plates. It represents a novel alveolar ridge preservation approach to restore the alveolar ridge at extraction sites with lost labial bone plates, even in the presence of chronic infection. However, future studies with sound methodology, larger sample sizes, and long follow-up periods are recommended to validate these findings.

The Mesh-Assisted Regenerated Site (MARS) technique restores the alveolar ridge at sites with lost labial plates by combining the osteoconductive properties of bone substitutes with the space-maintaining function of titanium mesh in a single procedure. This approach may reduce the need for extensive augmentation, shorten treatment duration, minimize complications, and potentially lower long-term treatment costs. The success of this approach depends on minimally traumatic extraction, meticulous socket debridement, careful soft tissue management, and precise placement of titanium mesh and bone substitutes under optimal magnification. Although effective, this technique has limitations, including potential vertical bone loss, time-consuming procedures, possible need for additional augmentation, occasional challenges with mesh retrieval, and infection risk, all of which may compromise regeneration and implant success. Proper case selection and precise application of the technique are essential to mitigate these challenges and optimize clinical outcomes.

When teeth are removed, the surrounding bone can shrink. Techniques to preserve this area, known as alveolar ridge preservation, help prevent this shrinkage. This novel technique uses specialized bone materials and a titanium mesh to rebuild the bone in areas where the front portion is missing. The author used a combination of bone materials and a titanium mesh to rebuild the lost bone. Key steps included stabilizing the mesh, thoroughly cleaning out any infection, layering the bone materials, and ensuring the gum tissue was not overly tight. The technique successfully reconstructed the missing bone, making it possible to place standard dental implants. Both cases showed significant bone growth with minimal issues. In one case, a small part of the mesh was exposed but did not impact healing and was addressed during follow-up surgery. This technique effectively rebuilt the lost bone, even with the presence of a long-standing infection. It shows promise for preserving and regenerating bone in these areas, but more extensive studies are needed to confirm the results and improve the method.

Lacertus syndrome is a proximal median nerve compression neuropathy characterized by weakness of flexor pollicis longus (FPL), index finger flexor digitorum profundus (FDP), and flexor carpi radialis (FCR) and pain with compression of the median nerve at the lacertus fibrosus. The purpose of this study was to investigate the efficacy of corticosteroid injection (CSI) for symptom management in lacertus syndrome.

A retrospective review of patients with lacertus syndrome who underwent lacertus CSI between 2016 and 2021 was performed. Patient demographics, history, and physical examination were extracted from the electronic medical record. Outcomes included subjective improvement in symptoms, physical examination findings, incidence of repeat lacertus CSI, and/or subsequent surgical lacertus fibrosus release.

A total of 64 patients met the inclusion criteria. Chief complaint included hand/forearm pain in 44 patients (69%), median nerve paresthesias in 49 patients (77%), and hand weakness in 9 patients (14%). On examination, 63 (98%) had tenderness at the lacertus fibrosus. Manual motor testing identified weakness of the index FDP in 50 patients, FPL weakness in 42 patients, and FCR weakness in 23 patients. Forty-eight (75%) patients had subjective improvement in symptoms following CSI. Seventeen patients who had an initial response to CSI subsequently underwent surgical lacertus release, with 16 of 17 surgical patients reporting postoperative symptom relief.

Seventy-five percent of patients with lacertus syndrome who underwent CSI at the lacertus fibrosus experienced at least temporary subjective symptomatic relief. Of the 35% of patients who had recurrent symptoms after CSI and underwent surgery, the vast majority experienced symptom relief.

The primary goal of this research was to design a useful and biocompatible nanofilm system (CNF) encapsulating chlorhexidine acetate (CHX) for wounds that is endowed with antibacterial and anti-inflammatory activities and promotes wound healing.

The nanofilm system was developed on the basis of the successful preparation of its nanoemulsion and PVA-CS film system and then important properties of the nanofilm system, including its morphological and physicochemical characteristics, stability and safety, its antimicrobial efficacy against P. aeruginosa was also evaluated in vitro and in vivo. The antibacterial effect, wound healing effect and inflammatory factor change in vivo were evaluated.

These results of this nanofilm system revealed a good particle size (59.27 nm) and stable zeta potential (-15.2 mV) that are suitable for wound healing applications. Additionally, it was stable, exhibited long-term stability (24 months) and sustained release in simulated wound fluid. Results showed that this nanofilm does not induce dose-related toxic effects and displays a better antibacterial effect that occurs more quickly, two times greater than that of CHX in vitro. This safe nanofilm enhances antibacterial activity against P. aeruginosa for 14 days, modulates the immune response, and accelerates skin wound healing in vivo.

These insights into multifunctional nanofilm designs for improved antibacterial effects and sustained release suggest promising clinical applications.

Fertility-sparing management is an option for young patients with gynaecological cancers, conferring comparable oncological and favourable reproductive outcomes as standard treatment. With delayed childbearing, the need for fertility-sparing treatment and demand for fertility preservation have increased. We describe the development of an oncofertility model of care at a tertiary hospital, along with our experiences.

This was a retrospective audit of patients who attended the OncoFertility Clinic, KK Women's and Children's Hospital, Singapore, from 9 September 2020 to 9 March 2023, focusing on the epidemiology and short-term outcomes.

A total of 144 women (median age 31 years) attended the OncoFertility Clinic, of whom 69 (47.9%) had uterine conditions, 65 (45.1%) had ovarian conditions, six (4.2%) had cervical conditions and four (2.8%) had synchronous uterine and ovarian conditions. Among the 45 women on fertility-sparing management for endometrial cancer, 66.7% had complete regression, 11.1% had persistent carcinoma and 22.2% regressed to endometrial hyperplasia. Fourteen women underwent in vitro fertilisation (IVF), resulting in three live births and one miscarriage. Thirty-two women had ovarian cancer, 23 had borderline ovarian tumours, one had Krukenberg tumour and nine had benign ovarian tumours. Fertility-sparing surgery was performed in 90.6% of the ovarian cancer cases. Fertility preservation was offered to twenty women, four of whom proceeded with fertility-preserving procedures. Three patients underwent assisted reproductive therapy. Four patients had surgery for suspected recurrences, but histologies were benign.

A multidisciplinary OncoFertility Clinic provides comprehensive counselling for young women with gynaecological cancers or precancers, addresses their reproductive health concerns, supports their decision-making and ensures timely access to fertility services.

In this systematic review and meta-analysis, we evaluated and compared the efficacy and safety of platelet-rich plasma injection into corticosteroid injection in the treatment of tendinopathy.

We searched PUBMED, EMBASE, Cochrane Library, SCOPUS, and Web of Science to identify randomized controlled trials on the PRP injection versus CS injection in treatment of tendinopathy.The meta-analysis was performed using the Revman 5.4 software.

We found 27 RCT studies with a total of 1779 patients enrolled. 8 rotator cuff injuries, 7 humeral external epicondylitis, 10 plantar fasciitis, and 2 tenosynovitis. The results of the meta-analysis showed that there were no significant group differences in the results of patients with rotator cuff injury comparing the pain visual analog scale score and functional measures at 1 month after receiving injection treatment. After three months of receiving PRP treatment, the VAS scores showed greater improvement compared to the CS group(OR = -1.64,95%CI [-2.97,-0.31],P = 0.02), while there was no statistically significant difference in shoulder joint function between the two groups at the 3-6 month post-treatment mark. Patients with plantar fasciitis showed no significant differences in VAS and AOFAS scores after receiving PRP or CS injections at 1 and 3 months. However, at the 6-month mark, the PRP group demonstrated significantly better VAS and AOFAS scores compared to the CS group(OR = -1.41,95%CI [-1.88,-0.44],P < 0.00001; OR = 7.19,95%CI [2.41,11.91],P = 0.003). 1 month after CS injection in patients with tenosynovitis, the VAS score was lower than that of the PRP group; patients with elbow epicondylitis had better improved upper limb function rating scale scores 1 month after CS injection compared to the PRP group. In patients with tenosynovitis, the VAS scores were superior to the CS group six months after PRP treatment(OR = -0.72,95%CI [-1.04,-0.40],P < 0.00001); similarly, patients with lateral epicondylitis exhibited better VAS, DASH scores than the CS group three and twelve months post-PRP treatment(OR = -9.76,95%CI [-10.89,-8.63],P = 0.0002; OR = -0.97,95%CI [-1.87,-0.06],P < 0.0001; OR = -18.03,95%CI [-31.61,-4.46],P = 0.009).

PRP can effectively improve pain and functional impairment in patients with tendinopathy, and its mid-term efficacy is superior to that of corticosteroids. However, the long-term efficacy remains to be further clinically verified.

This study explored yoga providers' clinical knowledge of arthritis, experiences of delivering yoga to people with arthritis, their perceived role in arthritis treatment, and perceived yoga training needs. Qualitative semi-structured interviews with 20 United Kingdom (UK)-based yoga providers were conducted. The interviews were digitally recorded, transcribed verbatim, and analysed thematically. The analysis generated eight themes. Yoga providers were generally aware of their attendees' health conditions and had clinical knowledge of arthritis through their yoga training. They were reasonably confident in delivering yoga to attendees with arthritis and felt that they had an important role in supporting these attendees. Gentle yoga practices were considered appropriate by the yoga providers, with a perception that a potential interplay between major components of yoga including yogic poses (asana), breathing practices (pranayama), and meditation (dhyana) and relaxation practices could help impart mind-body benefits in arthritis. Creating a safe and supportive environment in yoga sessions, being empathetic towards attendees' needs, and offering tailored modifications were perceived to be important for delivering yoga in arthritis treatment. Major system-level challenges to yoga delivery in arthritis treatment included the inadequate promotion of yoga, the unregulated nature of yoga delivery, and the absence of evidence-based arthritis-specific yoga training. Yoga providers felt they could play a key role in arthritis treatment in the UK, provided yoga is adequately promoted and made accessible to people with arthritis, yoga delivery is regulated, and arthritis-specific yoga training using the best available scientific evidence is made accessible to them.

The birth process involves biopsychosocial aspects, the identification of which has been little researched. This systematic review aims to identify biopsychosocial aspects of interventions during physiological birth in first-time mothers and to assess the effectiveness of these interventions on birth outcomes.A systematic guideline search resulted in the definition of a physiological birth of first-time mothers with a singleton from the cephalic position at 37+0 to 42+0 weeks' gestation. A systematic literature search assessed intervention studies for evidence quality using the GRADE methodology. Structured content analysis according to Mayring was used to identify biopsychosocial aspects.18 bio-organic, psychological and sociological aspects were identified from 20 studies. The quality of evidence was mostly low to very low due to inadequate reporting of fetal and maternal outcomes and characteristics. Moderate confidence was shown for midwifery care and aromatherapy in increasing spontaneous labor, and transcutaneous electrical nerve stimulation in improving satisfaction, subjective pain perception and APGAR score. Identified biopsychosocial aspects enable a multidimensional assessment of physiological birth and could lead to a biopsychosocial care model. Insufficient quality of evidence does not allow the derivation of specific interventions. Studies in obstetrics should use defined endpoints and characteristics to improve the quality of evidence.

The treatment of pelvic organ prolapse (POP) presents significant challenges. It is important to explore safer and more effective treatment modalities. Recombinant humanized collagen (rhCol) is a promising biomaterial with excellent biocompatibility and pro-regenerative properties. Therefore, this study aims to evaluate the potential applications of rhCol in POP treatment.

Vaginal wall tissues were collected from three non-POP and five POP patients to analyze extracellular matrix (ECM) changes via histological staining. Primary fibroblasts isolated from POP vaginal tissues were treated with rhCol III. Cell proliferation, migration, senescence, and ECM synthesis were assessed. A simulated birth injury (SBI) rat model was used to evaluate ECM remodeling following rhCol injection into the vaginal wall. Additionally, the angiogenic potential of rhCol III was examined in vivo and in vitro.

POP patient tissues and fibroblasts exhibited lower expression levels of type I and III collagen compared to non-POP samples. At a 1 mg/ml concentration, rhCol III promoted fibroblast proliferation and migration, reduced cellular senescence, and enhanced ECM synthesis. In the vaginal wall, the expression of COL1A1 and COL3A1 in the rhCol group was significantly higher than that in the SBI group, with a marked increase in the levels of CD31, CD34, and VEGFA. Furthermore, rhCol III improved the proliferation, migration, and tubule formation capacities of HUVECs.

rhCol III may promote ECM remodeling in an injured vaginal wall by restoring fibroblast function and stimulating angiogenesis, offering a novel biomaterial-based strategy for POP treatment.

Despite decades of healthcare provider training and investment, rates of utilization and capacity to appropriately plot the partograph and use it to make critical decisions remain sub-optimal in Sub-Saharan Africa. The objective of this review was to synthesize evidence of existing challenges and opportunities of partograph utilization in labor monitoring in Sub-Saharan Africa from existing literature. PUBMED, Cochrane Library of Trials, Google Scholar, and ScienceDirect databases published between January 1, 2013, and July 31, 2023, for studies reporting opportunities and challenges of utilizing the partograph in labor monitoring in Sub-Saharan Africa, were searched. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the identification of eligible studies. We utilized a Consolidated Framework for Implementation Research to interpret findings. The review protocol was registered under PROSPERO-CRD42023452882. Twenty-eight high-quality studies identified from a total of 452 in eight countries in Sub-Saharan Africa were analyzed in this review. Opportunities identified included 1) the partograph's uncontested potential to reduce maternal and neonatal mortality facilitated by good support supervision, formal and on-the-job training, active mentorships, and ongoing supervision, and the availability of enabling policies, standards, and protocols on partograph use; 2) the availability of partographs in health facilities. Gaps and challenges identified included 1) lack of inadequate training and tool complexity, 2) availability of different labor monitoring tools other than the partograph, 3) lack of motivation and feedback, 4) unavailability of the partograph in some health facilities, 5) shortage of staff in busy facilities, 6) lack of support supervision, 7) lack of protocols, 8) inappropriate motivation leading to 9) lack of commitment, negative attitude, negligence, careless partograph completion, or non-use. The challenges, opportunities, and lessons learned from this review on partograph utilization in labor monitoring will help develop suitable implementation strategies to guide the introduction and scale-up of the labor care guide in Sub-Saharan Africa if we are to avoid similar challenges.

Improvement of activity and participation for the disabled and chronically ill is an important aim of rehabilitation. Cervical dystonia is a neurological movement disorder characterized by involuntary contractions of the neck muscles. Until now, research has identified factors contributing to disability rather than factors which may make it easier to be active and participate in the community.

Explore and describe perceived experiences of activity and participation in daily life as experienced by persons with cervical dystonia.

Sixteen informants participated in this semi-structured interview study. Inductive qualitative content analysis was performed to understand and interpret experiences shared by the informants.

Results from the analysis generated two themes "An active life" and "A challenging life" and six sub-themes: Using helpful coping strategies, Accepting a new life situation, Adhering to BT treatment, Facing the negative impact of stress, Experiencing a negative self-image and Suffering from pain and fatigue.

Our results support the importance of actions using a rehabilitation approach that consider both motor and non-motor symptoms. Future studies should compare the effects of physiotherapy taking into account wishes and challenges in patients' everyday life versus traditional physiotherapy addressing mostly the motor disorder.

To explore the relationship between varying durations of sedentary time (ST) in hours per day and multimorbidity, while considering covariates such as non-compliance to moderate to vigorous physical activity (MVPA) recommendations, age, sex, and smoking in middle-aged and older adults.

Data from the first wave (2015-2016) of the nationally-representative Brazilian Longitudinal Study of Aging (ELSI-Brazil) were analyzed. Ordinary regression analysis was utilized to assess the odds ratio for individuals with varying daily ST durations concerning the escalation in the number of diseases while accounting for covariates such as failure to meet MVPA recommendations, age, sex, and smoking status.

A cohort of 7,314 individuals aged 50-105 years (56,3% females) participated in the study. The most prevalent occurrence of multimorbidity was having 2 conditions (1521/19.3%). A clear trend emerges, showing a rise in the number of multimorbidities as ST increase. Notably, individuals engaging in less than 4 h of daily ST exhibited a significantly lower likelihood of experiencing an increase in the total number of multimorbidity cases, with an odds ratio of 0.842 and a confidence interval of 0.764 to 0.928, even after adjusting for potential covariables.

Our findings indicate a progressive increase in multimorbidity with longer durations of ST. Moreover, limiting ST to less than 4 h daily was associated with a lower chance of multimorbidity.

This study sought to explore the management process of FOF among the older adults patients hospitalized due to falls. Semi-structured in-depth interviews were performed with 21 older patients. Three types of coping strategies were developed by hospitalized older adults: primary management of explaining the reason of falls by attributing it to inevitable consequence of aging as well as accidental events; secondary management of fear including self-consolation, downstairs comparison and distraction from fear, as well as confronting and reflecting fear; and tertiary management of the consequences of falling such as active rehabilitation, food therapy, seeking emotional support etc.

In this study, we analyze the oncological and functional outcomes after minimally invasive surgery (laparoscopic and robotic) for mid and low rectal adenocarcinoma. This is a narrative review of articles published from January 2019 to December 2024 in which we analyzed the rate of short-term oncological outcomes (quality of surgical samples), long-term oncological outcomes (recurrence rate, overall survival, and disease-free survival), and functional disorders (urinary, sexual, and bowel function) after minimally invasive surgery. The rates of complete mesorectum are 67.7%-92.8%, the rate of free circumferential resection margin is 94%-98.2%, and the rate of free distal resection margin is 99.4%-100%. The local recurrence rate is 2.3%-7.3%, the overall survival rate is 80%-95.6%, and the disease-free survival rate is 70%-86.4%. The rate of urinary disorders is 25%-26.5%, sexual disorders are 35%-80%, and bowel disorders are 17%-44.6%. This review demonstrates that minimally invasive surgery yields favorable oncological and functional outcomes. The continuous evolution in robotic surgery will increasingly lead to interesting implications for rectal surgery, thanks to less surgical trauma and better intraoperative visualization of nerves.

A retrospective single-centre study. To investigate the period prevalence of pressure injury recurrence (PIR) and characteristics associated with PIR in the population of persons with spinal cord injury (SCI) who were treated with flap surgery between 2008 and 2019. A spinal cord unit (SCU) in Norway. The study is based on analysis of patient data from the electronic medical record. Crosstabs and logistic regression were used to investigate the potential correlations between the odds of PIR and potential risk characteristics. We identified 54 patients who were treated with flap surgery in the period of interest, and 47 (87%) were men. The mean age for flap surgery was 51 years (SD = 12.7). The occurrence of PIR post-flap surgery was 46% (n = 25). Factors associated with increased risk of PIR were use of manual wheelchair (65% vs. 32%, odds ratio [OR] = 3.9, 95% confidence interval [CI] = 1.06-14.33, p = 0.04) when compared with powered wheelchair, and history of PI and flap surgery at the ischial tuberosity (sit bones) (68% vs. 24%, OR = 3.67, 95% CI = 1.01-13.40, p = 0.04) compared with all other body locations. Factors associated with decreased risk of PIR were independence in position changes (29% vs. 58%, OR = 0.29, 95% CI = 0.91-0.95, p = 0.04) compared with not needing assistance with position changes, tetraplegia (C5-C8) (21% vs. 60%, OR = 0.18, CI = 0.04-0.83, p = 0.02) compared with paraplegia, and postoperative follow-up by the SCU (15% vs. 55%, OR = 0.28, 95% CI 0.03-0.76, p = 0.04) compared with no follow-up from the SCU, as well assistance from personal assistant follow-up (PAF) (26% vs. 56%, OR = 0.15, 95% CI = 0.03-0.76, p = 0.01) compared with not receiving assistance from PAF. The period prevalence of PIR post-flap surgery in the Norwegian population of people with SCI is high and increased odds of PIR were related to flap surgery on the sit bones. Reduced odds of PIR were related to tetraplegia, powered wheelchair use, follow up by PAF and the SCU. The study is registered in the Open science framework.

Blood flow restriction creates a state with increased motor function that permits treatment modalities to induce muscle hypertrophy. Blood flow-restricted exercise training (BFRET) may induce motor learning and boost the facilitatory effect of exercise training (ET).

This study investigated the effects of BFRET on post-stroke hemi paretic lower extremity function and walking capacity recovery.

This randomized clinical trial was conducted from September 2021 to October 2022 at the Department of Rehabilitation Medicine of the Second Affiliated Hospital of Chongqing Medical University in China. Participants were randomized 1:1 to BFRET or ET, each involving 30 minutes of training twice per day for 4 weeks.

The main outcomes were manual muscle testing (MMT) and Fugl-Meyer assessment scale-lower extremity (FMA-LE), the timed up and go test (TUGT), Outcomes were assessed by blinded raters after 4 weeks of training.

40 participants mean [SD] age 48.79[12.58] years, 30 males [75%], 20 were randomized to BFRET and 20 to ET. The mean (SD) time since stroke was 2.5 (1.3) years. The MMT scores showed greater strength by within-group comparisons and superior changes in hip flexion and plantar flexion in the BFRET group.

BFRET is superior to ET alone in enhancing muscle mass and strength in the lower extremities. BFRET may improve the function of the lower extremities through physiological adaptations for muscle hypertrophy.

URL: https://www.clinicaltrials.gov; Unique identifier: ChiCTR2100050206.

This study aimed to systematically review the research on home pharmaceutical care and to identify emerging trends and research hotspots using bibliometric methods.

Publications related to home pharmaceutical care, published from inception to 6 February 2025, were extracted from the Web of Science Core Collection (WoSCC). The bibliometric tool CiteSpace was employed to analyze various metrics, including the number of publications, contributing countries, institutions, authors, keywords, cited references, and research trends in the field of home pharmaceutical care.

A total of 812 relevant articles were retrieved from the WoSCC. The most prolific contributors were Hughes CM, Nishtala, PS, and Lapane KL. The United States emerged as the leading country in the field, with Queen's University Belfast identified as the most productive institution. The keyword with the highest frequency was "pharmaceutical care." The research hotspots in this field were centered around "polypharmacy," "medication reconciliation," and "drug-related problems."

This study utilized CiteSpace to analyze research trends and hotspots in the field of home pharmaceutical care. The findings suggest that "polypharmacy" and "care homes" are likely to become focal points of future research. Additionally, the development of research in developing countries lags behind that in developed countries. Therefore, it is crucial for developing countries to learn from the advances made by developed nations in this field, and to foster greater international collaboration and research efforts.

Aging is frequently characterized by an inadequate primary vaccine response, likely due to immunosenescence and inflamm-aging, a low-level, chronic inflammatory state. Both aspects increase the susceptibility of older adults to viral and bacterial infections, resulting in a higher frequency and severity of infectious diseases. In this preliminary study, a cohort of 52 individuals was recruited and divided into two groups: young (age range 21-35) and older adults (> 60 years old). Peripheral blood mononuclear cells (PBMCs) were collected before (time 0, T0) and after (time 1, T1) the immunization with a tetravalent influenza vaccine. Then, T cell immunophenotyping analysis was conducted to investigate how aging and influenza vaccination influence T cell responses. Additionally, the anti-inflammatory and antioxidant effects of oleuropein (OLE), a secoiridoid extracted from extra virgin olive oil, alone or in combination with BIRB 796, a potent inhibitor of p38 MAPK, were explored to enhancing the impact of influenza virus on T cell activation, aiming to identify potential alternatives or complementary strategies to improve traditional flu-vaccine formulations. Statistically significant observations were noted for a decrement in CD8 + T naïve and an increase of effector memory between the young and older adults after flu-vaccination. Moreover, preliminary findings indicate anti-inflammatory and antioxidant properties of OLE and BIRB 796 on T cell responses, particularly regarding Reactive Oxygen Species/Reactive Nitrogen Species modulation, with a trend toward the decrease of pro-inflammatory cytokines (i.e., Interferon-γ (INF-γ), Tumor Necrosis Factor-α (TNF-α)), αalthough without statistical significance.

This article addresses theoretical and clinical aspects of radiation-induced intestinal injuries, which complicate radiation therapy for malignant neoplasms of the abdominal and pelvic organs. Many clinical aspects of this issue remain unknown due to the lack of awareness among doctors and patients. Further study of radiation-induced intestinal injuries and the development of personalized approaches to their prevention and treatment represent a relevant direction in internal medicine.

General health checks are integral to preventive services in many healthcare systems. They are offered, for example, through national programmes or commercial providers. Usually, general health checks consist of several screening tests to assess the overall health of clients who present without symptoms, aiming to reduce the population's morbidity and mortality. A 2019 Cochrane review of effectiveness studies suggested that general health checks have little or no effect on either all-cause mortality, cancer or cardiovascular mortality or cardiovascular morbidity. These findings emphasise the need to explore the values of different stakeholder groups associated with general health checks.

To identify how stakeholders (i.e. healthcare managers or policymakers, healthcare providers, and clients) perceive and experience general health checks and experience influencing factors relevant to the commissioning, delivery and uptake of general health checks. Also, to supplement and contextualise the findings and conclusions of a 2019 Cochrane effectiveness review by Krogsbøll and colleagues.

We searched MEDLINE (Ovid) and CINAHL (EBSCO) and conducted citation-based searches (e.g. reference lists, effectiveness review-associated studies and cited references in our included studies). The original searches cover the period from inception to August 2022. The results from the update search in September 2023 have not yet been incorporated.

We included primary studies that utilised qualitative methods for data collection and analysis. Included studies explored perceptions and experiences of commissioning, delivery and uptake of general health checks. Stakeholders of interest were healthcare managers, policymakers, healthcare providers and adults who participate (clients) or do not participate (potential clients) in general health checks. The general health check had to include screening tests for at least two diseases or risk factors. We considered studies conducted in any country, setting, and language.

We applied a prespecified sampling frame to purposefully sample a variety of eligible studies. This sampling approach allowed us to capture conceptually rich studies that described the viewpoints of different stakeholder groups from diverse geographical regions and different settings. Using the framework synthesis approach, we developed a framework representing individual, intervention and contextual factors, which guided data extraction and synthesis. We assessed the methodological limitations of each study using an adapted version of the Critical Appraisals Skills Programme (CASP) tool. We applied the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess our confidence in each finding.

One hundred and forty-six studies met the inclusion criteria, and we sampled 36 of these for our analysis. While most of the studies were set in high-income countries in Europe, nearly a third (11/36) were set in culturally diverse middle-income countries across Eastern Europe, South and Southeast Asia, and Latin America. Sixteen sampled studies were conducted in primary and community healthcare settings, four in workplace settings and four in community settings. Included studies explored the perceptions and experiences of clients (n = 25), healthcare providers (n = 15) and healthcare managers or commissioners (n = 9). We grouped the findings at the individual level, intervention level and surrounding context. The findings at the individual level mainly reflect the client's perspective. General health checks helped motivate most clients to change their lifestyles. They were trusted to assess their health objectively, finding reassurance through professional confirmation (moderate confidence). However, those who feared negative results or relied on symptom-based care were more reluctant to attend (moderate confidence). Perceptions of disease, risk factors and prevention affected uptake (high confidence). Some clients felt an obligation to their families and society to maintain and improve their health through general health checks (moderate confidence). Healthcare providers played a crucial role in motivating participation, but negative experiences with unqualified providers discouraged attendance (moderate confidence). The availability and accessibility of general health checks and awareness systems played significant roles in clients' decision-making. Factors such as time and concerns that health insurance may not cover potential treatment costs influenced attendance (moderate confidence). The findings at the intervention level drew on the perspectives of all three stakeholder groups, with a strong focus on the healthcare provider's perspective. Healthcare providers and clients considered it essential that general health check providers were skilled and culturally competent (high confidence). Barriers to delivery included time competition with curative care, staff changes and shortages, resource limitations, technical issues, and reimbursement challenges (moderate confidence). Stakeholders thought innovative and diverse settings might improve access (moderate confidence). The evidence suggests that clients appreciated a comprehensive approach, with various tests. At the same time, healthcare providers deemed individualised approaches tailored to clients' health risks suitable, focusing on improving rather than abandoning general health checks (low confidence). The perspectives on the effectiveness of general health checks differed among healthcare commissioners, managers, providers, and clients (moderate confidence). Healthcare providers and clients recognised the importance of information, invitation systems, and educational approaches to create awareness of general health check availability and their respective advantages or disadvantages (moderate confidence). Clients considered explaining test results and providing recommendations as key elements of general health checks (low confidence). We have low or very low confidence in findings related to the contextual level and reasons for commissioning general health checks. The evidence suggests that cultural background, social norms, religion, gender, and language shape the perception of prevention and disease, thereby influencing the uptake of general health checks. Policymakers thought that a favourable political climate and support from various stakeholders are needed to establish general health checks.

Despite the lack of effectiveness in the quantitative review, our findings showed that general health checks remain popular amongst clients, healthcare providers, managers and policymakers across countries and settings. Our data did not offer strong evidence on why these are commissioned, but it did point to these interventions being valued in contexts where general health checks have long been established. General health checks fulfil specific wants and needs, and de-implementation strategies may need to offer alternatives before a constructive debate can take place about fundamental changes to this widely popular or, at least, accepted service.

Cerebral ischemia-reperfusion injury (CIRI) is a complex pathophysiological process faced by brain tissues after ischemic stroke treatment, which involves mechanisms of inflammatory response, oxidative stress and apoptosis, and severely affects treatment outcome. Lipocalin-2 (LCN2), an acute-phase protein, is significantly up-regulated after CIRI and promotes neural repair by enhancing astrocyte phagocytosis, but its over-activation may also trigger secondary inflammation and demyelination injury. LCN2 also plays a key role in neuroinflammation regulation by regulating the polarization state of astrocytes and the release of inflammatory factors, and may affect the integrity of the blood-brain barrier and a variety of pathologic injury processes. In view of the important role of LCN2 in CIRI, this article reviews the mechanism of LCN2, aiming to provide new ideas and methods for the treatment of ischemic stroke.

Pediatric pustular psoriasis (PPP) is an autoimmune skin disease that seriously affects the physical and mental health of children. The IL-36RN (Interleukin-36 Receptor Antagonist) gene plays a key role in the pathogenesis of PPP. This review comprehensively elaborates on the research progress of IL-36RN in the context of the pathogenesis and treatment of PPP, covering the basic structure, function, mutation sites and types, and inheritance patterns of the gene and its role in the pathogenesis of PPP. In addition, we discussed the frequency of IL-36RN mutations in patients with different types of PPP and the treatment methods for these patients, aiming to provide a valuable reference for further research and treatment of this disease.

Differentiated Service Delivery models (DSD) that cater to the needs of key populations (KP) have shown promise in providing KP-sensitive and KP-tailored care and treatment services. We evaluated the effect of two DSD models on linkage to and retention in treatment in Nigeria.

Between December 2017 and June 2018, newly-diagnosed men who have sex with men (MSM) and female sex workers (FSWs) were enrolled into treatment through two DSD models and followed prospectively for one year. Model 1 was a fully integrated one-stop-shop (OSS) while model 2 was a hybrid HIV prevention and treatment site (DIC). Retention was estimated from drug pick-up records and was defined as being on treatment within 90 days one-year post ART initiation. Cox regression was used to identify the independent effect of the DSD models on retention while probability of being retained in treatment at 1-year was estimated with Kaplan-Meier product limit.

A total of 605 newly-diagnosed clients were enrolled into the study (340 in OSS and 265 in DIC; 342 were FSWs, while 263 were MSM). Median age was 26 years for MSM and 30 years for FSWs. Among those linked to treatment, retention was higher in the OSS than in DIC (63% vs. 48%; p = 0.002). Among those not retained, mean days to be lost-to-follow up (LFTU) was 60 days. Controlling for educational level, population type and age, clients who received treatment in M2 were 6 times more likely not to be retained in treatment at the end of 1 year (Hazard ratio 5.89; 95% CI: 1.04-33.16). The Kaplan Meier estimates of the probability of being retained in 6 months, 9 months and 12 months was 0.97, 0.92, 0.80 for the DIC and 1.00, 0.96, 0.91 for the OSS.

Linkage to treatment was suboptimal across both models with less than 90% of newly-diagnosed positives initiated on treatment and suggests that facilitated linkage is required to achieve at least 95%. Though retention was higher in the OSS model, both models had an alarmingly short time frame for LTFU and thus intensive monitoring during this phase of treatment is recommended irrespective of the type of DSD. Addressing these gaps will improve service delivery by one stop shops for HIV care and treatment.