The clinical and economic burden among patients with non-thermal full-thickness wounds (NFTW) resulting from trauma or surgery and undergoing autologous skin grafts is not well characterized. Assessing burden of care can inform treatment choice, evaluation of emerging wound therapies, and payer coverage decisions. Clarivate's Real-world Data Repository® national claims database between 01/01/2019 and 08/31/2024 was used to select patients aged ≥ 15 years with a primary NFTW diagnosis who underwent an autologous skin graft procedure (index). Separate cohorts were analyzed according to the site of care where the index procedure was performed (inpatient, outpatient hospital, office/clinic). Kaplan-Meier estimates of the 90-day post-index adverse outcome rates, select adjunct procedures, and select medication use were generated. All-cause 12-month healthcare resource utilization (HRU) and costs [in 2024 United States (US) dollars] were also estimated. Of the 26,117 patients with a NFTW, the mean age was 59.3 years and 43.3% were female. During the 12-month pre-index period 41.2% were smokers, 32.0% were obese, 31.8% had diabetes or diabetes-related comorbidities, and 21.5% were malnourished. Drug or alcohol abuse (15.6%), frailty (13.6%), and autoimmune diseases/immunodeficiency (10.4%) were also common. Traumatic wounds accounted for 56.1% and surgical wounds for 29.7% of all cases. Within 90 days, regrafting and graft failure occurred in 7.6% and 4.9% of the inpatient cohort, 3.4% and 3.1% of the outpatient hospital cohort, and 3.5% and 0.1% of the office/clinic cohort, respectively. Total mean annual costs were $266,231 (standard deviation (SD) = $458,484] per patient in the inpatient, $62,619 (SD = $132,510) in the outpatient hospital, and $14,261 (SD = $36,894) in the office/clinic cohorts with an average all-cohort cost of $128,959 (SD = $306,485). Patients receiving autologous skin grafts for NFTW are medically complex with high rates of complications and significant costs, highlighting the need for novel interventions or adjunct therapies to reduce the associated clinical and economic burden. Nonthermal full-thickness wounds are severe injuries that damage the skin and often require autologous skin grafts to heal. This study looked at over 26,000 people in the United States who received autologous skin grafts for non-thermal full-thickness wounds between 2019 and 2024. Many of these patients had other health problems including diabetes, obesity, or poor nutrition, which made their care more complicated. The study found that patients with non-thermal full-thickness wounds undergoing skin grafting need intense care and their average healthcare costs exceeded $128,000 over 12 months. This study suggests that new treatment approaches are needed to help reduce complications and costs.
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Phenotypic plasticity can influence population persistence, range dynamics, and evolutionary potential in heterogeneous landscapes. If adaptive, plasticity may buffer populations against environmental variability, climate change, and extreme events. Yet, few studies have examined how plasticity and its evolution vary across species' ranges. This is especially important for edge populations, which are often most vulnerable to novel conditions. The Climate Variability Hypothesis postulates that greater environmental variability selects for genotypes that exhibit greater phenotypic plasticity. However, field tests of this hypothesis across species' ranges remain rare. Using scarlet monkeyflower (Mimulus cardinalis), we combined a resurrection approach with common gardens to test whether (1) central and edge populations differ in plasticity in drought-associated traits, (2) there were evolutionary shifts in plasticity following an extreme drought, and (3) plasticity was adaptive. We measured plasticity in first flower date, specific leaf area, and leaf dry matter content across two leading-edge, two range-center, and two trailing-edge populations, comparing pre-drought ancestors and post-drought descendants grown in three gardens spanning the latitudinal range following a historic drought event. We found significant plasticity in all traits, and plasticity in the date of first flower was greatest in trailing-edge populations that have experienced greater interannual variation in precipitation. Evolutionary changes in plasticity occurred in some populations but did not consistently increase first-year fitness. The adaptive value of plasticity was trait-specific. These results show that plasticity is shaped by both spatial and temporal environmental variation and highlight the need to examine trait- and population-level responses to understand selection on plasticity at range edges.
Bullous pemphigoid (BP) is the most common autoimmune blistering disease in older adults and is increasingly associated with dipeptidyl peptidase-4 (DPP-4) inhibitors used in type 2 diabetes mellitus. Sitagliptin-associated BP is uncommon and may be complicated by secondary infections and multisystem involvement. A 74-year-old female with type 2 diabetes mellitus and hypertension presented with generalized weakness, burning micturition, abdominal pain, painful blistering skin lesions, and oral erosions. She had been receiving sitagliptin 100 mg once daily for approximately 2 years before symptom onset. Skin biopsy demonstrated a subepidermal bulla with eosinophilic infiltrates, suggestive of BP. Sitagliptin was discontinued after admission. The hospital course was complicated by bilateral pyelonephritis with multidrug-resistant urosepsis requiring bilateral double-J stenting, oral candidiasis caused by Candida albicans, recurrent gastrointestinal bleeding, and tubulovillous adenoma with high-grade dysplasia. Persistent dermatologic disease with markedly elevated immunoglobulin E levels necessitated omalizumab therapy, resulting in gradual improvement. Sitagliptin-associated BP should be considered in elderly diabetic patients presenting with blistering disorders after prolonged gliptin exposure. Early diagnosis, withdrawal of the suspected drug, histopathological confirmation, and multidisciplinary management are essential for favorable outcomes. RésuméLa pemphigoïde bulleuse (PB) est la maladie bulleuse auto-immune la plus fréquente chez les personnes âgées et est de plus en plus associée aux inhibiteurs de la dipeptidyl peptidase-4 (DPP-4) utilisés dans le traitement du diabète sucré de type 2. La PB associée à la sitagliptine est peu fréquente et peut être compliquée par des infections secondaires ainsi que par une atteinte multisystémique. Une femme de 74 ans, atteinte de diabète sucré de type 2 et d’hypertension artérielle, s’est présentée avec une faiblesse généralisée, des brûlures mictionnelles, des douleurs abdominales, des lésions cutanées bulleuses douloureuses et des érosions buccales. Elle recevait de la sitagliptine à la dose de 100 mg une fois par jour depuis environ deux ans avant l’apparition des symptômes. La biopsie cutanée a mis en évidence une bulle sous-épidermique avec un infiltrat riche en éosinophiles, évocateur d’une pemphigoïde bulleuse. La sitagliptine a été arrêtée après l’admission à l’hôpital. L’évolution hospitalière a été compliquée par une pyélonéphrite bilatérale avec urosepsis dû à des bactéries multirésistantes, nécessitant la mise en place bilatérale de sondes urétérales double J, une candidose buccale causée par Candida albicans, des épisodes récurrents d’hémorragie gastro-intestinale, ainsi qu’un adénome tubulo-villeux présentant une dysplasie de haut grade. La persistance de l’atteinte dermatologique, associée à des taux très élevés d’immunoglobuline E, a nécessité un traitement par omalizumab, entraînant une amélioration progressive. La pemphigoïde bulleuse associée à la sitagliptine doit être évoquée chez les patients diabétiques âgés présentant des maladies bulleuses après une exposition prolongée aux gliptines. Un diagnostic précoce, l’arrêt du médicament suspect, la confirmation histopathologique et une prise en charge multidisciplinaire sont essentiels pour obtenir une évolution favorable.
To evaluate inter-device agreement of device-designated chord mu and chord alpha measurements, defined as device-designated linear displacements between the Purkinje reflex and the pupil center (chord mu) or limbal center (chord alpha), by four common devices: IOLMaster 700 (Carl Zeiss Meditec AG), Lenstar 900 (Haag-Streit), iTrace (Tracey Technologies), and Pentacam (Oculus Optikgeräte GmbH). This was a retrospective cross-sectional study of patients undergoing preoperative cataract evaluation at a tertiary academic center. Eyes with measurements from all four devices between 2020 and 2023 were included. Exclusion criteria included prior ocular trauma, surgery, or pathology affecting imaging. Chord mu and alpha were analyzed using bivariate methods, including centroid direction and inter-device comparisons. Biometry and corneal curvature were also analyzed. A total of 110 eyes from 77 patients (mean age: 63 ± 11 years) were included. Across devices, mean chord mu values were approximately 0.35 ± 0.20 mm and mean chord alpha values were approximately 0.45 ± 0.23 mm, with substantial variability in both magnitude and orientation. Most pairwise inter-device comparisons demonstrated statistically significant differences for both chord mu and chord alpha. The IOLMaster 700 consistently demonstrated temporal centroid displacement and the widest directional dispersion, whereas other devices showed predominantly nasal centroid orientation. Left and right eyes demonstrated similar patterns but were analyzed separately. Clinically relevant inter-device differences in magnitude and orientation of chord mu and chord alpha were observed, with systematic centroid shifts and directional dispersion. These device-specific offsets indicate that such measurements are not interchangeable across platforms and should be interpreted in the context of the measuring device when applied to surgical planning.
While chemotherapy-induced alopecia (CIA) is a concern for patients with cancer, investigations involving men with CIA are limited. We aimed to examine sex differences in chemotherapy-related distress using the Japanese version of the Chemotherapy-Induced Alopecia Distress Scale (CADS-J). The study, conducted at Toranomon and Yokohama Minami Kyosai Hospitals between March and December 2023, employed a one-time 17-item questionnaire survey (CADS-J) for patients with cancer who had not previously experienced CIA-related hair loss. Each item was scored from 0 (none) to 3 (severe), with total scores ranging from 0 to 51. Of 104 patients who received the questionnaire, 97 were included in the analysis (men, 55 [56.7%]; mean age, 62.6 ± 12.7 years). Metastatic disease was present in 92.7% and 50% of the men and women, respectively. Pancreatic (35%) and gastric (16%) cancers were most common in the men; while pancreatic (26%) and breast (24%) cancers were most common in the women. Common terminology criteria for adverse events (CTCAE) grade 2 CIA was observed in 70.9% and 95.2% of the men and women, respectively. Mean CADS-J total scores were: men, 5.7; women, 13.2 (p < 0.001); women scored significantly higher in every domain. In a multivariable analysis, female sex, wig or hat use, and depressive symptoms (Center for Epidemiologic Studies Depression Scale ≥ 16) were independently associated with higher CADS-J total scores. Among the men, 5/55 (9.1%) had CADS-J total scores ≥ 13 (the female mean); of whom four (80%) had CTCAE grade 2 CIA and wore a wig or hat. To our knowledge, this is the first study to report sex differences in distress associated with CIA using CADS-J. Distress was stronger in women, but some men also experienced marked distress. Further research and clinical evaluations are needed to individualize targeted care.
The use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) is increasing in the treatment of obesity and type 2 diabetes mellitus. Some patients taking these medications undergo cranial or spinal surgical procedures. Delayed gastric emptying is a key mechanism of action for these medications. Despite the standard preoperative fasting period, there is a risk of residual gastric contents remaining in the perioperative period. Since neurosurgical patients face a risk of postoperative complications such as aspiration, delayed extubation, and postoperative nausea and vomiting, there is a need for a clinically focused review. We performed a structured narrative review of perioperative studies, gastric ultrasound reports, meta-analyses, and professional society guidance addressing GLP-1RA use in anesthesia, surgery, and procedural sedation. Evidence was qualitatively synthesized with particular attention to procedural and physiologic factors relevant to neurosurgical practice, including urgent surgery, prone positioning, posterior fossa pathology, and baseline bulbar dysfunction. Current evidence consistently links the use of GLP-1 receptor agonists (GLP-1RAs) with an increased likelihood of gastric retention, particularly during dose escalation and in patients with active gastrointestinal symptoms. However, population-level studies and meta-analyses have not shown an increase in pulmonary aspiration rates. Although aspiration is not very common in neurosurgical patients, when it does occur, its consequences may be more severe than expected. Direct evidence specific to neurosurgery in the perioperative setting remains limited. A practical perioperative management approach structured according to risk level can assist in assessing the patient's symptoms and stage of treatment. It can also ensure that procedure-specific risk factors are taken into account, appropriate risk-reduction measures are selected, and the resumption of medication in the postoperative period is individualized. Due to the limited evidence specific to neurosurgery, these assessments should not be interpreted as evidence-based neurosurgery guidelines. They should instead be viewed as expert-driven extrapolations adapted from the broader perioperative literature to neurosurgical practice.
Background: Endometrial cancer (EC) is a common gynecological malignancy with increasing incidence. While several serum biomarkers have been studied for EC, their combined prognostic value remains unclear. This study aimed to evaluate the prognostic significance of preoperative serum CA125, CA19-9, CA72-4, CEA, and AFP levels in EC patients and develop a risk score for predicting survival outcomes. Methods: A retrospective cohort study of 2,081 EC patients was conducted at Shengjing Hospital of China Medical University. Serum biomarker levels and clinicopathological data were collected. Univariate and multivariate Cox proportional hazard models were used to identify independent prognostic factors. A risk score based on CA125, CEA, and AFP levels was developed using LASSO-Cox regression, and nomograms were constructed for survival prediction. Results: Multivariate analysis identified elevated CA125 (P=0.003), AFP (P<0.0001), and CEA (P=0.014) as independent factors for overall survival (OS). These markers were also independent predictors of progression-free survival (PFS). The risk score incorporating CA125, AFP, and CEA was an independent indicator for both PFS (P<0.0001) and OS (P<0.0001). Nomograms based on the risk score and clinicopathological features demonstrated good predictive ability and calibration for survival outcomes. Conclusions: The risk score based on preoperative serum levels of CA125, CEA, and AFP is a valuable prognostic tool for predicting PFS and OS in EC patients. Nomograms incorporating this risk score accurately predict EC prognosis and may aid in clinical decision-making. Funding: This study was supported by the National Key R&D Program of China (Program Nos. 2022YFC2704400, The National Natural Science Foundation of China (No. 81872123 and 81472438); University innovation team of Liaoning Province; Special Professor of Liaoning Province 'Major Special Construction Plan' for Discipline Construction of China Medical University in 2018 (No. 3110118029); Outstanding Scientific Fund of Shengjing Hospital(No. 201601) 'Major Special Construction Plan' for Discipline Construction of China Medical University in 2018.
Skin aging is a complex process driven by multiplex factors, including chronic inflammation and UV exposure. It has become common practice for cosmetic formulations to counteract skin aging by targeting different pathways simultaneously with a pool of active ingredients. The present study aims to explore the skin protective effects of a novel extract of ferment in combination with copper tripeptide-1 GHK-Cu from an anti-inflammation perspective. An extract of the Thermus thermophilus and Bacillus subtilis mixed-culture ferment (TBFE) was prepared and the skin protective effects of its combination with the human tripeptide derivative GHK-Cu were explored through in vitro, ex vivo, and clinical tests. The combination outperformed TBFE or GHK-Cu alone in inhibiting secretion of inflammatory cytokines by lipopolysaccharide-stimulated macrophages. In addition, one face cream formulated with the combination as the sole active ingredients protected human skin explants from ultraviolet irradiation induced damage by maintaining skin morphology and decreasing the degradation of extracellular matrix. Finally, results from the clinical study demonstrated that the combination was effective in decreasing wrinkles and improving skin barrier conditions. It is concluded that the combination of TBFE and GHK-Cu exerts anti-aging effects on human skin by targeting inflammation, extracellular matrix, and skin barrier function. Therefore, the combination offers a promising option for anti-aging skincare regimen by addressing multiple mechanisms involved in skin aging.
Chickenpox (varicella) is a common childhood viral illness that is usually self-limiting; however, it may be complicated by secondary bacterial skin infections, particularly in pediatric populations. These secondary infections contribute significantly to morbidity, prolonged hospital stays, and increased healthcare utilization. The present study aims to determine the incidence of secondary skin infections among children affected with chickenpox and to identify associated risk factors. A descriptive observational study was conducted among children diagnosed with chickenpox over a period of 1 year. Clinical evaluation was performed to identify signs of secondary skin infections, and relevant demographic and clinical data were collected. The incidence of secondary skin infections was calculated, and common bacterial pathogens and clinical outcomes were analyzed. The findings indicate that a notable proportion of children with chickenpox develop secondary skin infections, most commonly impetigo, cellulitis, and abscesses, with Staphylococcus aureus and Streptococcus pyogenes being the predominant pathogens. Factors such as poor hygiene, scratching of lesions, malnutrition, and delayed medical care were found to increase the risk of infection. Early recognition and appropriate management of secondary skin infections are essential to reduce complications. Preventive strategies, including health education and varicella vaccination, play a crucial role in minimizing the incidence and severity of these infections. Résumé Contexte:La varicelle est une maladie virale fréquente de l’enfance, généralement bénigne et spontanément résolutive. Cependant, elle peut être compliquée par des infections cutanées bactériennes secondaires, en particulier chez les enfants. Ces infections secondaires contribuent de manière significative à la morbidité, à la prolongation de la durée d’hospitalisation et à l’augmentation de l’utilisation des ressources de santé. La présente étude vise à déterminer l’incidence des infections cutanées secondaires chez les enfants atteints de varicelle et à identifier les facteurs de risque associés.Méthodologie:Une étude observationnelle descriptive a été menée auprès d’enfants diagnostiqués avec la varicelle sur une période d’un an. Une évaluation clinique a été réalisée afin d’identifier les signes d’infections cutanées secondaires, et des données démographiques et cliniques pertinentes ont été recueillies. L’incidence des infections cutanées secondaires a été calculée, et les principaux agents pathogènes bactériens ainsi que les issues cliniques ont été analysés.Résultats:Les résultats indiquent qu’une proportion notable d’enfants atteints de varicelle développe des infections cutanées secondaires, les plus fréquentes étant l’impétigo, la cellulite infectieuse et les abcès. Les principaux agents pathogènes identifiés étaient Staphylococcus aureus et Streptococcus pyogenes. Des facteurs tels qu’une mauvaise hygiène, le grattage des lésions, la malnutrition et un recours tardif aux soins médicaux ont été associés à un risque accru d’infection.Conclusion:La reconnaissance précoce et la prise en charge appropriée des infections cutanées secondaires sont essentielles pour réduire les complications. Les stratégies de prévention, notamment l’éducation sanitaire et la vaccination contre la varicelle, jouent un rôle crucial dans la réduction de l’incidence et de la gravité de ces infections.
Autism spectrum disorder (ASD) is a heterogeneous condition that has led some to question whether IQ scores can be meaningfully compared across neurodivergent and neurotypical populations. The purpose of this study was to evaluate the measurement invariance of the Stanford-Binet Intelligence Scales, Fifth Edition (SB-5), among 3,050 clinically referred youth ages 2-16 with a diagnosis of ASD (n = 1,329; 43.6%), ADHD (n = 942; 30.9%), or a language-related disorder (n = 779; 25.5%), as well as the general population standardization sample within the same age range. The clinical sample consisted of retrospective chart review data from a large pediatric hospital in the Midwestern United States. We used multigroup confirmatory factor analysis to test measurement invariance. The three clinical groups demonstrated full strong (scalar) invariance. The combined clinical sample also demonstrated full strong (scalar) invariance relative to the standardization sample. These findings indicate that the SB-5 measures IQ in a consistent manner across both general and clinical populations, including the three most common neurodevelopmental disorders, supporting the meaningful comparison of scores across these groups.
Opioid prescription counts are increasing across Europe and in Switzerland, yet inappropriate co-prescribing of opioids is common, with serious unintended clinical effects. There is limited information about the opioid stewardship programmes (OSPs) implemented in Europe and Switzerland. The present study surveyed OSPs in Switzerland's hospitals to characterize implemented OSPs and assessed their association with staffing. A 30-item questionnaire was sent to the director of every pharmacy in Switzerland's national hospital pharmacy association (n = 69). It addressed the pharmacy-reported use of seven types of OSP previously identified in the literature: automated decision support, opioid use guidelines, staff training, discussions of opioid issues/questions in committees, the availability of naloxone, interventions for appropriate opioid use and the monitoring of consumption. Thirty-one of the 69 institutions completed the survey (45%) and a further nine responded partially (13%). Hospitals had implemented a median of three of the seven OSPs covered (interquartile range: 2-5). Infrequently implemented OSPs included alert systems to detect high-risk situations involving opioids (15%), opioid use guidelines (41%), education on safe opioid use (32%) and monitoring of opioid or naloxone use (42%). Committees on safe opioid use (59%) and clinical pharmacy interventions addressing safe opioid use (62%) were more frequently implemented. Naloxone was rapidly available in all institutions. Switzerland's hospitals rarely implement the seven types of OSPs identified, suggesting that more coordinated approaches to improving opioid safety are needed. Our interpretations should be treated cautiously, nevertheless, due to potential non-response bias.
Wigner negativity and genuine multipartite entanglement (GME) are key nonclassical resources that enable computational advantages and broader quantum-information tasks. In this Letter, we prove two theorems for multimode continuous-variable systems that relate these nonclassical resources. Both theorems show that sufficient Wigner negativity-either a sufficiently-large Wigner negativity volume along a suitably chosen two-dimensional slice, or a sufficiently large nonclassicality depth of the center-of-mass mode of a system-certifies the presence of GME. Moreover, violations of the latter inequality provide lower bounds of the trace distance to the set of non-GME states. Our results also provide sufficient conditions for generating GME by interfering a state with the vacuum through a multiport interferometer, complementing long-known necessary conditions. Beyond these fundamental connections, our methods have practical advantages for systems with native phase-space measurements: they require only measuring the Wigner function over a finite region, or measuring a finite number of characteristic function points. Such measurements are frequently performed with readouts common in circuit and cavity quantum electrodynamic systems, trapped ions and atoms, and circuit quantum acoustodynamic systems. As such, our GME criteria are readily implementable in these platforms.
Acute myocardial infarction (AMI) is a major global health burden. Current diagnostic reliance on high-sensitivity cardiac troponin (hs-cTn) is limited by its lack of disease specificity and inability to reveal upstream molecular and immune mechanisms. This study aimed to identify robust core genes and their functional networks in AMI via integrated multi-dataset analysis and experimental validation. Three peripheral blood transcriptomic datasets (GSE60993, GSE61144, GSE97320) were obtained from GEO. Differentially expressed genes (DEGs) were identified using limma, with common DEGs extracted. Diagnostic performance was evaluated via ROC curves. Functional annotation used GO, KEGG and GSEA. Immune infiltration was analyzed with CIBERSORT. Key genes were validated in H9C2 cells under oxygen-glucose deprivation (OGD) using RT-qPCR and Western blot. Eight core genes were consistently upregulated in AMI peripheral blood, all showing high diagnostic accuracy (AUC > 0.80). They were enriched in immune-inflammatory pathways. GSEA identified three activated pathways: adipocytokine signaling, leukocyte transendothelial migration and insulin signaling, with ACSL1, MMP9 and PYGL as key drivers. Immune analysis revealed increased neutrophils and decreased γδ T cells, with all eight genes positively correlating with neutrophil infiltration. The OGD model in H9C2 cells confirmed specific upregulation of GPR97, PROK2, ALPL and PADI4. This integrated computational and experimental study identifies a set of high-value diagnostic core genes in AMI. It first validates the specific upregulation of novel genes (GPR97, PROK2) in myocardial ischemia, placing them within a pathological network involving metabolic, immune and protective pathways. These findings provide new molecular insights and a foundation for novel diagnostics and therapeutic targets.
Although spinal cord stimulation (SCS) is an established neuromodulatory therapy for chronic pain, its gastrointestinal (GI) effects beyond analgesia remain poorly characterized. This study synthesized the current evidence describing nonpain GI changes associated with permanent SCS implantation. A systematic search of PubMed, Web of Science, and Scopus was conducted on April 25, 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Studies describing permanent SCS implantation with percutaneous or paddle leads in patients with baseline GI complaints and/or inducing GI changes were included. Animal models, reviews, and nonpermanent trial-only stimulations were excluded. The Oxford Centre for Evidence-Based Medicine hierarchy, study-design-specific methodologic quality assessments, and the Grading of Recommendations Assessment, Development, and Evaluation framework were used to assess study quality. Study characteristics, patient demographics, lead placement, stimulation paradigms, and GI outcomes were extracted. Nonpain GI effects were categorized as desired or undesired on the basis of the clinical direction of change relative to baseline. Overall, 21 studies comprising 143 patients were included, predominantly comprising case reports/series, along with two retrospective cohort studies, two prospective single-arm studies, and one randomized cross-over pilot trial. Most SCS implantations were performed for abdominal or visceral pain (88.8%). Thoracic lead placement was most common (69.2%), and 10-kHz stimulation was the predominant paradigm (46.2%). A total of 86 desired GI changes and 13 undesired GI changes were reported. The most frequent desired effects were decreased nausea (32.6%) and reduced diarrhea (12.8%), whereas worsened nausea (23.1%) was the most common adverse effect, followed by diarrhea (15.4%) and constipation (15.4%). GI changes have been identified with SCS use, most commonly improvements in nausea and bowel function, although adverse effects have been reported. Current evidence remains limited by heterogeneity and low certainty, highlighting the need for controlled studies with standardized GI outcome measures.
Alcohol and tobacco are risk factors for non-communicable disease and deaths in England. People using both substances have increased health risks. While increasing tax on each product has been shown to reduce consumption and harm, little research has examined effects of changing both taxes together. Work package 1: describe potential tobacco and alcohol tax policies; work package 2: analyse purchasing patterns across population subgroups; work package 3: estimate industry tax-pass-through; consumer response to price changes for 12 products; work package 4: simulate impact of 33 policy options, United Kingdom Government 2021 proposals to restructure alcohol duty and (after project end date) 2023 alcohol duty reform. Work package 1 reviewed literature and interviewed stakeholders to identify policy options. Work package 2 analysed repeat cross-sectional survey data on purchasing. Work package 3 used quantile regression on market research data to estimate tax pass-through and a two-stage Tobit model to estimate consumer responses (own-price and cross-price elasticities) for 12 products (beer, cider, wine, spirits and ready-to-drinks, split off-trade/on-trade; cigarettes, roll-your-own tobacco). Work package 4 developed tax modelling for the Sheffield Tobacco and Alcohol Policy Model (v2.1.0) to analyse work package 1 policy options. Later, version v2.4.2 was used to analyse emerging policy on alcohol duty reforms. Effects of United Kingdom tax policies in England, covering 2017-50. Life course simulation of individuals aged 18-89; 2017-50. Tax policies changes: (1) specific duty per product, (2) duty escalators for alcohol and tobacco, and Minimum Excise Tax on tobacco, (3) hypothetical strength-based alcohol taxes, (4) United Kingdom Government's 2021 proposals for alcohol duty reform and (5) analysis of United Kingdom Government's implemented Alcohol Duty Reform 2023. Changes in participation in drinking or smoking, amounts consumed, expenditures, Government tax revenues, retailer revenues, risks of hospitalisation and death from over 60 clinical conditions, National Health Service secondary costs, quality-adjusted life-years, mortality and health inequalities. Work package 1 identified policy options. Work package 2 showed variations in expenditure by subgroup. Work package 3 showed that retailers increased prices of expensive products by more than expected after tax rises, keeping cheap product prices lower. Work package 3 showed statistically significant participation and consumption price responsiveness for all 12 products. Work package 4 compared 33 policies, showing that higher tax increases, especially for cider and hand-rolled tobacco, are effective at reducing smoking rates, drinking and deaths over 20 years. Effects were largest for people living in more deprived areas. Tailored modelling (after project end date) examined United Kingdom Government's 2023 implemented alcohol duty reform, estimating a small reduction in alcohol consumption and deaths. In contrast, a policy to increase cider taxes to be in line with beer could result in a 30 times larger reduction in deaths. Uncertainty in estimates remains. Data used were collected pre-coronavirus disease discovered in 2019. Sales data were from legal retailers; illicit tobacco was not examined. Each sub-study has its own data limitations. Combined increases in tax on tobacco and alcohol could potentially be more effective at reducing disease, National Health Service costs, deaths and health inequalities than raising tax on only one product. Potential trade-offs could exist between health benefits and effects of tobacco and alcohol tax increases on financial burden for those who continue consuming both products. Future tobacco or alcohol tax analyses should factor in inter-linkages between both commodities. We are adapting modelling infrastructure to deliver responsive within-days modelling for new government proposals and budgets. Further work on price elasticities in other countries would be useful. Future analyses will incorporate post-coronavirus disease discovered in 2019 data. We are extending modelling to other United Kingdom countries, and pricing policies beyond tax (e.g. minimum pricing). We are extending analyses to no and low alcohol products and to evaluate observed impacts of the government's alcohol duty reforms. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 16/105/26. Alcohol and tobacco cause many diseases and deaths in England. People who drink heavily are more likely to be smokers. People who smoke and drink heavily are more likely to get ill and die sooner. Increasing alcohol tax has been shown to reduce drinking and increasing tobacco tax has been shown to reduce smoking. But, no research has looked at changing alcohol and tobacco taxes together. We spoke to alcohol and tobacco tax experts to understand tax policy options. We used market research and survey data to examine: how shops pass tobacco tax increases through to consumer prices, how pubs and supermarkets pass through alcohol tax increases to customers, and how much people respond to price changes by quitting smoking or reducing the amount they smoke or drink. We developed a computer model to estimate the effects of 33 possible tax changes, covering the range of changes to tax structures and levels considered to be ‘on the table’. When new United Kingdom Government reforms for alcohol tax were proposed (2021) and implemented (2023), we estimated their effects. When a tax rise happens for alcohol or tobacco, retailers increase prices of expensive products by more than expected and keep cheap product prices lower than expected. When alcohol or tobacco prices rise, some people respond by quitting smoking and reducing their tobacco or alcohol consumption. Computer simulation comparing 33 policies estimates that higher tax increases, especially for cider and hand-rolled tobacco, are likely to be effective at reducing rates of smoking, amount of drinking, and deaths over 20 years. Effects are largest for people in the most deprived areas. The United Kingdom Government’s 2021 proposals and 2023 implemented policy for restructuring alcohol taxes are estimated to result in small reductions in drinking and deaths, but a policy to increase cider taxes in line with beer could substantially reduce deaths. Computer modelling suggests increasing alcohol and tobacco taxes together could be effective in reducing deaths, hospitalisations and National Health Service costs and also reducing inequalities in health between areas. The modelling also enables consideration of the potential unintended consequence of increasing costs for people already with relatively little disposable income if they do not reduce their consumption. It is important for analysis of changes in either alcohol taxes or tobacco taxes to estimate the knock-on effects to consumption and harms from both products. Text in this section reproduces material from HatchardText in this section reproduces material from Hatchard et al.. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The text below includes minor additions and formatting changes to the original text.This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The text below includes minor additions and formatting changes to the original text.
Needlestick injuries (NSIs) are a major occupational hazard among healthcare workers and expose them to serious blood-borne infections such as hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. Healthcare workers in teaching hospitals, particularly interns and residents, are at increased risk due to limited experience, high workload, and frequent involvement in invasive procedures. Despite the availability of universal precautions, NSIs continue to occur and are often underreported. The objectives of this study were to assess the knowledge, attitude, and practices regarding NSIs among healthcare workers and residents, to evaluate reporting behavior and postexposure management, and to identify gaps between knowledge and safe practices. A cross-sectional, questionnaire-based study was conducted among 160 healthcare workers and residents at a tertiary care teaching hospital. Data on demographic characteristics, knowledge, attitude, practices, and reporting behavior related to NSIs were collected using a structured questionnaire. Data were analyzed using SPSS version 25. Associations were assessed using the Chi-square test, and P < 0.05 was considered statistically significant. The majority of participants were aged ≤30 years (65.0%) and had ≤5 years of clinical experience (61.3%). Nearly half of the participants had experienced a NSI. Healthcare workers with more than 5 years of experience demonstrated significantly better knowledge regarding NSIs (P = 0.009). Nursing staff and residents showed a significantly more positive attitude toward NSI prevention compared to interns (P = 0.015). Adequate knowledge was significantly associated with safer needle handling practices (P = 0.013); however, a substantial knowledge-practice gap persisted. Reporting of NSIs was significantly higher among participants aware of postexposure prophylaxis (P = 0.005). NSIs remain common among healthcare workers, particularly early-career staff. Although knowledge and attitude were satisfactory, unsafe practices and underreporting were prevalent. Regular training, reinforcement of universal precautions, and effective reporting systems are essential to reduce occupational exposure. Résumé Contexte:Les blessures par piqûre d’aiguille (BPA) constituent un risque professionnel majeur pour les travailleurs de la santé et les exposent à des infections transmissibles par le sang potentiellement graves, telles que le virus de l’hépatite B (VHB), le virus de l’hépatite C (VHC) et le virus de l’immunodéficience humaine (VIH). Les professionnels de santé exerçant dans les hôpitaux universitaires, en particulier les internes et les résidents, sont davantage exposés en raison de leur expérience limitée, de leur charge de travail élevée et de leur participation fréquente à des procédures invasives. Malgré la disponibilité des précautions universelles, les BPA continuent de survenir et sont souvent sous-déclarées.Objectifs:Cette étude visait à évaluer les connaissances, les attitudes et les pratiques relatives aux blessures par piqûre d’aiguille chez les professionnels de santé et les résidents, à examiner les comportements de déclaration et la prise en charge post-exposition, ainsi qu’à identifier les écarts entre les connaissances et les pratiques sécuritaires.Matériels et méthodes:Une étude transversale basée sur un questionnaire a été menée auprès de 160 professionnels de santé et résidents dans un hôpital universitaire tertiaire. Les données concernant les caractéristiques démographiques, les connaissances, les attitudes, les pratiques et les comportements de déclaration liés aux BPA ont été recueillies à l’aide d’un questionnaire structuré. Les données ont été analysées avec le logiciel SPSS version 25. Les associations ont été évaluées à l’aide du test du Chi carré, avec un seuil de signification statistique fixé à P < 0,05.Résultats:La majorité des participants étaient âgés de ≤ 30 ans (65,0 %) et possédaient ≤ 5 ans d’expérience clinique (61,3 %). Près de la moitié des participants avaient déjà subi une BPA. Les professionnels de santé ayant plus de 5 ans d’expérience présentaient des connaissances significativement meilleures concernant les BPA (P = 0,009). Le personnel infirmier et les résidents manifestaient une attitude significativement plus positive envers la prévention des BPA que les internes (P = 0,015). Un niveau de connaissances adéquat était significativement associé à des pratiques plus sûres de manipulation des aiguilles (P = 0,013) ; toutefois, un écart important entre les connaissances et les pratiques persistait. La déclaration des BPA était significativement plus fréquente chez les participants connaissant la prophylaxie post-exposition (P = 0,005).Conclusion:Les blessures par piqûre d’aiguille demeurent fréquentes chez les professionnels de santé, en particulier parmi le personnel en début de carrière. Bien que les connaissances et les attitudes soient globalement satisfaisantes, les pratiques non sécuritaires et la sous-déclaration restent courantes. Des formations régulières, le renforcement des précautions universelles et la mise en place de systèmes efficaces de déclaration sont essentiels pour réduire l’exposition professionnelle.
Chronic subdural hematoma (CSDH) is among the commonest cranial neurosurgical conditions of older adults and is projected, on the basis of incidence modeling, to become the most common cranial neurosurgical condition in adults by 2030. Despite this clinical centrality, CSDH has not been formally examined through the conceptual lens of geroscience. This minireview reframes CSDH as a geroscience disease by mapping its pathogenesis onto the twelve hallmarks of aging articulated by López-Otín and colleagues. Two hallmarks have strong direct support in the existing CSDH literature. Chronic inflammation and altered intercellular communication both manifest in the inflammaging fingerprint of hematoma fluid and in the dysregulated paracrine signaling of the outer neomembrane. Cellular senescence is the most fertile moderate-evidence hallmark. The molecular signature of the senescence-associated secretory phenotype overlaps closely with the cytokine, chemokine, and matrix remodeling milieu of the CSDH cavity, but no study has yet demonstrated senescent cells in resected neomembrane tissue. Mitochondrial dysfunction, deregulated nutrient sensing, and loss of proteostasis have weak inferential support. Four hallmarks, namely, genomic instability, telomere attrition, epigenetic alterations, and stem cell exhaustion, are essentially unstudied in CSDH and are framed as research priorities. Disabled macroautophagy and dysbiosis have recently received initial direct measurements but remain only partially addressed. The 2024 randomized trials of middle meningeal artery embolization, the success of atorvastatin in the ATOCH trial, and emerging senolytic clinical translation collectively suggest that CSDH may be a tractable target for future mechanism-directed gerotherapeutic interventions. The most actionable contribution of this framework is to specify which experiments would convert CSDH from a surgical emergency of older adults into an exemplar of clinical geroscience.
Paracetamol (acetaminophen) overdose is a common cause of drug-induced hepatocellular injury and represents an important clinical emergency requiring timely evaluation and evidence-based management. N-acetylcysteine (NAC) remains the established antidote for preventing the progression of hepatic injury when administered promptly. We describe the case of an 18-year-old female who intentionally ingested eight tablets of paracetamol (650 mg each; total dose 5.2 g) and four tablets of cetirizine (10 mg each) following psychosocial distress. On presentation, she reported abdominal pain and had a history of transient altered consciousness prior to hospital arrival. Initial biochemical evaluation demonstrated mild hepatocellular injury, with serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels of 250 IU/L and 300 IU/L, respectively, while serum bilirubin and coagulation parameters (PT/INR) remained within normal limits, indicating the absence of acute liver failure. Following clinical assessment, the patient underwent gastric decontamination and received the standard intravenous NAC regimen, supportive therapy, serial monitoring of liver function, and comprehensive psychiatric evaluation. Liver enzyme concentrations progressively declined during hospitalization, reaching AST 60 IU/L and ALT 70 IU/L by day 3, with complete clinical recovery and no evidence of hepatic complications. Psychiatric assessment identified underlying psychosocial factors contributing to the intentional overdose, and appropriate pharmacological treatment and follow-up were initiated before discharge. This case demonstrates that favorable outcomes can be achieved through early risk assessment, guideline-directed NAC therapy, serial biochemical monitoring, and multidisciplinary management addressing both the toxicological and psychosocial aspects of intentional paracetamol overdose.
Interprofessional collaboration is essential to address the complex challenges in primary care. One widely used method for this purpose is interprofessional team meetings. Although the benefits are generally known, maintaining these meetings after their introduction remains challenging. To understand the aspects influencing the sustainability of interprofessional team meetings. An exploratory qualitative study was conducted with professionals (n = 39) from seven interprofessional teams that met regularly to coordinate elderly patient care. Data were collected through seven focus group discussions. Content analysis was applied, guided by the Consolidated Framework for Sustainability, to identify barriers, facilitators, and needs. Common barriers included unclear networks, lack of shared goals, and limited time, whereas facilitators involved strong team dynamics, clear structures, and flexibility. These findings point to five key needs: (i) adaptive team composition in response to patient care issues, (ii) shared ownership within interprofessional teams, (iii) shared meetings' aims and work agreements, (iv) a balanced structure with clear procedures, supportive tools and room for flexibility, (v) and a satisfactory perceived quality of the meetings. This study shows that nurturing team dynamics, tailoring organisational structures, and embedding ongoing evaluation are essential beyond patient care. This may need a new way of thinking to enhance the sustainability of interprofessional team meetings in primary care. Reflection within interprofessional teams helps to understand aspects that influence the sustainability of meetings.Creating a safe space for open communication and negotiating goals and expectations may enhance sustainability.Interprofessional meetings should be embedded in the organisational structure with clear tasks, procedures, responsibilities, and sufficient time should be allocated for participation.