Controversial efforts to censor the term pudendum and related pudendal anatomical terminology from Terminologia Anatomica (TA) have been met with mounting criticisms. The proponents of censorship have deemed pudere-related terminology nondescriptive and "unscientific." However, its etymology refers to the hair which covers the underlying genitalia and renders the underlying anatomy less conspicuous. Accordingly, the terminology speaks to location (the region covered by the hair), structure/function (the hair covering which obscures the view of underlying structures), and human development (pubarche). Moreover, pudere-related terminology is increasingly used in modern-day science and, therefore, "scientific" by virtue of its utility. Aside from human anatomy, pudere-related scientific terminology is used to describe nearly 1000 species from varied kingdoms, genera, and so on, and the nature of being or becoming inconspicuous. Proponents of censorship have argued the false pretense that biologists would regard as 'shameful' the essential functions undertaken by structures in the perineum based upon ancient etymology. They have also argued that pudere-related terms, including pudendal nerve, are somehow sexist, despite being used indiscriminately of sex for millennia. As a result of misleading information, the International Federation of Associations of Anatomists and its Federative International Committee for Equality and Diversity in Anatomy have recommended replacing pudendal terminology with perineal terminology, which would confound longstanding anatomical language. Because censorship of well-established anatomical terminology may impair communication, it is important to highlight erroneous reasons for censorship when they occur. Therefore, this report highlights several flaws in the logic regarding the censorship of pudere-related terms.
Despite the documented reliance on family caregivers, systems and programming to support family caregivers are often not inclusive, nor do they provide culturally relevant opportunities. Cultural factors, in part, may be useful to understanding disparities in care outcomes and to inform support mechanisms for caregivers. However, there is lack of specificity of terminology to describe how culture is considered in dementia care interventions. The purpose of this Forum manuscript is to clarify the meaning of the terminology of culture (i.e., cultural tailoring, cultural adaptation) and to provide exemplars of evidenced-based supports that utilized the term in dementia caregiving support. This work aims to demonstrate the importance of culturally informed interventions to address disparities in care outcomes and to offer best practices to advance the science of culturally informed dementia care interventions.
The Chinese translation of "carbohydrate" has long been a topic of considerable debate in chemistry, biomedicine, and nutrition-related disciplines. This issue is not merely linguistic. In Chinese-language contexts, inconsistency among carbohydrate-related expressions may create ambiguity in nutrition education and public understanding, and may introduce practical challenges for literature retrieval and interdisciplinary collaboration, especially in fields such as type 2 diabetes mellitus (T2DM), where distinctions among dietary carbohydrates, sugars, and glucose could be crucial. This article traces the historical evolution of the Chinese translation of "carbohydrate" to clarify its historical trajectory and scientific implications. Historical evidence demonstrates that the term "carbohydrate" did not appear in dictionaries or chemistry books published prior to 1900. However, at the turn of the 20th century, multiple translations emerged, most of which were influenced by the Japanese term "tansuikabutsu/." The earliest recorded Chinese translation appeared in Huaxue Yuanliu Lun. During the early Republic of China, "tanshui huawu/" became the most commonly used term, which was later revised around 1920 with the addition of a semantic radical to the character "tan." In 1932, the National Institute for Compilation and Translation introduced the term "tang/," which gained popularity alongside "tanshui hua(he) wu." However, "tang" was officially abolished in the mid-to-late 1950s and gradually phased out in subsequent decades. By 1980, "tanshui huahe wu/)" and "tang lei/" were officially established as equivalent translations. Currently, "tang lei" is preferred in some disciplinary standards, although "tanshui huahe wu" remains widely used by convention. By reviewing this history, the present work highlights three key principles for addressing terminological ambiguity in nutrition communication. While this historical narrative is anchored in the Chinese context, the communication risks and mitigation strategies discussed might be relevant to other cross-lingual or cross-disciplinary setting, where everyday dietary language interfaces with technical biomedical terminology.
Terminology used to describe products applied to the vulva and vagina is inconsistent and poorly standardized, limiting clarity in research, clinical practice, and regulation. Products marketed under the umbrella of "feminine hygiene" or "intimate care" include both menstrual management items and products intended primarily for aesthetic purposes, such as douches, sprays, wipes, and scented tampons. The use of health-oriented language such as "hygiene" and "care" may imply medical necessity or health benefit despite limited evidence of therapeutic value and growing concern regarding chemical exposures associated with some of these products. Ambiguous terminology may obscure product function, hinder risk communication, and contribute to regulatory and research gaps. We propose the term intimate cosmetics to describe vulvovaginal products intended for aesthetic purposes rather than for menstrual management. This terminology aligns with established regulatory definitions of cosmetics as products applied to the body for cleansing, beautifying, or altering appearance, without implying disease prevention or treatment. Reframing these products as cosmetics more accurately reflects their intended use and clarifies distinctions between aesthetic and health-promoting interventions. Many intimate cosmetics contain fragrances and other chemicals associated with endocrine disruption, reproductive toxicity, or carcinogenicity, yet marketing claims such as "gynecologist tested" or "pH balanced" may confer an impression of clinical legitimacy. Clear, function-based terminology can improve research categorization, enhance post-market safety monitoring, and support more transparent regulatory oversight. Importantly, imprecise and gendered language may also reinforce stigma and obscure patterns of disproportionate exposure among populations already overburdened by environmental toxicants. Adopting the term intimate cosmetics represents a practical public health strategy to improve precision in scientific discourse, strengthen risk communication, and promote more equitable regulatory attention. Intentional, function-based nomenclature can better align product labeling, research, and policy with exposure realities and consumer protection goals.
C. Wang, Y. Jing, W. Yu, J. Gu, Z. Wei, A. Chen, Y.-T. Yen, X. He, L. Cen, A. Chen, X. Song, Y. Wu, L. Yu, G. Tao, B. Liu, S. Wang, B. Xue, and R. Li, "Bivalent Gadolinium Ions Forming Injectable Hydrogels for Simultaneous In Situ Vaccination Therapy and Imaging of Soft Tissue Sarcoma," Advanced Healthcare Materials 12, no. 26 (2023): 2300877, https://doi.org/10.1002/adhm.202300877. The above article, published online on 11 August 2023 in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the authors; the journal Editor-in-Chief, Uta Goebel; and Wiley-VCH GmbH. A third party alerted the editor to concerns about an error in terminology: Divalent/bivalent Gadolinium2+ is referenced throughout the text, but the dominant and correct form is trivalent (Gadolinium3+). The authors acknowledge this error, noting that the stable oxidation state of gadolinium under physiological conditions is indeed +3, not +2. They confirm that this was an error in chemical terminology, not in the materials or experimental design, as the commercially available Gd(III)-gadodiamide was used. Additionally, the authors identified an error in the hematoxylin and eosin (H&E) staining results of Figure 9, in which a subpanel was mistakenly replaced with a duplicate image from an alternate set of H&E staining images that the authors had prepared with different scale bars for visual optimization. The authors note that this error occurred during file reorganization and was unintentional. Because of these errors that impact the study's premise and results, the article must be retracted. A revised version of this article is available here: [https://doi.org/10.1002/adhm.71182].
The ocular surface is known to respond in certain ways in the aircraft environment, with subsequent symptomatic consequences for the individual. This has been found in several studies, which revealed symptoms of dry eye disease, while also demonstrating objective signs. Thus, with the increase in direct ultra long-haul flights, there needs to be a further understanding of the impact of flying on the eye and specifically, the ocular surface. The aim of this review is to explore existing knowledge on the impact of the aircraft environment on the ocular surface, with the aim of guiding future advancements in this area. Google Scholar, PubMed, and ScienceDirect electronic databases were used to identify studies conducted on the ocular surface in the aircraft environment. Terminology used for aircraft included "aeroplane," "airplane," "aircraft," "flying," "long flights," and "flights," and terminology used for ocular surface included "dry eye," "ocular surface," "ocular allergy," and "environmental exposures." Thirty studies were retrieved. It was found that the primary risk factors in the aircraft environment that affect the ocular surface include relative humidity, temperature, air velocity, atmospheric pressure, and air quality. The aircraft environment affects the ocular surface in a number of ways, and strategies to mitigate these effects should be explored in future studies.
Digital health and connected technologies may support better health outcomes among older adults, including those with multiple chronic conditions or low engagement in health behaviors. However, initial experiences with technology, including during unboxing, setup, and first use, can influence emotional reactions and perceptions and can ultimately determine sustained, meaningful use. Older adults with low technology experience or poor health may be particularly vulnerable to frustration, stress, or abandonment of devices when early interactions are negative. The purpose of this implementation study was to closely observe the initial engagements with a telehealth treatment app and connected blood pressure monitor (BPM) among a group of older adults with low prior technology use and reported low health behavior engagement. The goal was to identify setup "pain points" that may influence initial impressions and intention to use the technology over time. A total of 24 older adults (aged ≥65 years) were recruited for a 4-week trial of a telehealth app. Participants were provided with a box containing a tablet preloaded with the app, paper instructions, and a BPM and cuff. Researchers first conducted in-home ethnographic interviews with participants to observe the unboxing and setup process, documenting experiences with reading instructions, using the BPM, and engaging with customer support. Weekly check-in calls and a final exit interview captured ongoing experiences and likelihood of continued use. Interview recordings were transcribed and independently coded, guided by the unified theory of acceptance and use of technology. Most of the sample were White (20/24, 83%) and female (14/24, 58%). Negative experiences with the app's customer support were the top challenge for participants, with representatives providing confusing steps or conflicting terminology. Other common challenges were understanding instructions, connecting to Bluetooth, and correctly using the BPM. While 67% (16/24) of the participants indicated that they were likely or very likely to continue to use the app after the study ended at the end of week 1, this number dropped to 54% (13/24) by the end of the 4 weeks. Participants who reported lower technology self-efficacy at the beginning of the study also experienced frustration, anxiety, and embarrassment as friction with the setup process continued. First impressions of digital health apps play a critical role in influencing older adults' emotions and perceptions regarding the technology and may impact the likelihood of longer-term engagement. Those with lower technology self-efficacy are particularly susceptible to experiencing negative emotions such as frustration, stress, or shame. Mobile health apps and interventions targeting older adults should incorporate simplified instructions with clear, consistent terminology and well-trained customer support staff to improve the onboarding experience.
Assessing patient perspectives is fundamental to determining whether anti-racism and cultural training programs and services associated with an intervention achieve their intended outcomes, yet reviews frequently focus on health provider perspectives. This systematic review, therefore, aimed to investigate First Nations Peoples' experiences, as patients, of interventions to improve their Cultural Safety and experiences in secondary and tertiary healthcare settings. American Psychological Association's PsycInfo (via EBSCOhost), Cumulative Index to Nursing and Allied Health Literature Complete (via EBSCOhost); PubMed and Scopus (via Elsevier) were all searched from inception to 9 December 2025. Eligible intervention studies needed to report the experiences of First Nations' people as care recipients in secondary and tertiary healthcare settings. Eligible study countries were Australia, Canada, Aotearoa (New Zealand) and the United States of America (USA). General study quality was assessed using the Mixed Methods Appraisal Tool. Study quality was also examined with a modified version of the Aboriginal and Torres Strait Islander Quality Appraisal Tool to provide a First Nations perspective. Qualitative meta-aggregation was conducted to synthesise both qualitative and quantitative data. There were 22 reports (11 qualitative, seven quantitative and four mixed methods) of 20 eligible studies, including 2,092 First Nations care recipients. Interventions and quantitative outcomes were heterogeneous, precluding meta-analysis. Four studies reported on cultural training for health professionals, with the remainder service-level interventions. The qualitative meta-aggregation resulted in six synthesised findings, which reflected the mechanisms by which these programs worked and their outcomes. Four synthesised findings described mechanisms. These included emotional and practical support; acknowledgement, respect and support for culture; feeling accepted, heard, valued, safe, comfortable and respected; and navigating treatment and the system. The two synthesised findings related to outcomes concerned perceptions of health services and, relatedly, impacts on health service access. Quality appraisal revealed no discussion of existing and newly created intellectual property considerations. Study limitations included undefined terminology, terms being used interchangeably and few studies from the USA and Aotearoa (New Zealand). Published intervention studies assessing First Nations care recipients' experiences appear to be increasing. Future interventions must clearly define the terminology in the intervention, use mixed methods approaches and report intellectual property considerations. Systematic review: PROSPERO, CRD42024521218 (prospective, available at https://www.crd.york.ac.uk/PROSPERO/view/CRD42024521218).
Atrial fibrillation (AF) is a common cardiac dysrhythmia encountered in the Emergency Department (ED) setting. The term, 'recent-onset AF', whilst inconsistently defined across protocols and guidelines, generally refers to the 48-h window for cardioversion when used in the ED setting. A clear terminology and taxonomy of AF is needed to guide ED clinicians, researchers and patients with respect to AF and its acute presentation to the ED. In this article, we discuss the current inconsistencies with terminology pertaining to acute AF and present evidence to support the use of the term 'acute recent-onset AF'. In addition, a three-part taxonomy is suggested to better delineate the various presentations of AF to the ED.
In August 2025, an updated International Multidisciplinary Classification of Interstitial Pneumonias was released by the European Respiratory Society (ERS) and American Thoracic Society (ATS). For the first time, the "idiopathic-only" paradigm has been transcended through the integration of secondary interstitial lung diseases (ILD) into a unified framework. Grounded in recent advances in ILD research, major changes have been introduced to disease patterns, diagnostic terminology, subcategories, and diagnostic approach. Actual histopathologic findings are more accurately represented by the new schema, and clearer, more actionable guidance for patient management is provided to clinicians. The pathological dimensions of the update are highlighted herein, with key innovations outlined, newly introduced subcategories, terminologies, and categorization systems elucidated, and a systematic overview of the histological characteristics of major patterns offered. Additionally, the opportunities and challenges that the new classification presents to pathologists are discussed. 2025年8月，欧洲呼吸学会（European Respiratory Society，ERS）/美国胸科学会（American Thoracic Society，ATS）发布新版《间质性肺炎国际多学科分类》更新，首次突破“特发性”框架，将继发性间质性肺病纳入统一体系，并依据近年来间质性肺病的相关研究进展对疾病模式、诊断术语、亚类分组、诊断方法等作出重大调整。新分类更加贴近疾病实际病理学表现，也为临床治疗管理提供了更强的指导价值。本文将聚焦其中的病理相关内容，梳理核心变革，解读新增亚类、术语与分组设置，系统描述主要模式的组织学特征，并探讨更新给病理医师带来的机遇与挑战。.
Periprosthetic joint infections (PJIs) following primary and revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) have been studied, but a contemporary large-scale analysis of incidence has not been performed. This study assessed PJI incidence and trends for TKA, THA, rTKA, and rTHA using a contemporary database. Epic Cosmos database was retrospectively queried (2015-2023). Current procedureal terminology codes identified patients: 27447 (TKA), 27130 (THA), 27486 (rTKA one component), 27487 (rTKA both components), 27134 (rTHA both components), 27137 (rTHA acetabular component), and 27138 (rTHA femoral component). PJI rates were identified using International Classification of Diseases 9/10 codes and analyzed using linear regression. A total of 1,658,742 cases were identified: 962,967 TKA, 600,225 THA, 59,212 rTKA, and 36,338 rTHA. PJI rates for TKA were 0.25% (30 days) and 1.19% (1 year). PJI rates for THA were 0.46% (30 days) and 1.28% (1 year). One-year PJI rates from 2015 to 2023 decreased 17% for TKA and 40% for THA (P = .001). The 1-year PJI rate for rTKA (all types) was 6.51%, differing between one-component (9.34%) and both components (4.68%) (P = .001). The 1-year PJI rate for rTHA (all types) was 8.78%, differing between both-components (8.79%), acetabular component (8.62%), and femoral component (8.88%) (P = .01). One-year PJI rates were not correlated with year of surgery for rTKA or rTHA (P = .43, P = .08). Significant PJI reduction after primary TKA and THA was observed over the last decade, but infection rates remained stable in revision cohorts. Further investigations are required to assess underlying reasons for observed PJI rate reductions following primary arthroplasty.
Digital health technologies (DHTs) represent a clear potential to advance the science of pharmacovigilance and promote patient safety. A project was created to assess the current landscape for use of DHTs and identify opportunities to use DHTs in fulfilling these objectives. TransCelerate Biopharma Inc, a non-profit launched in 2012 to accelerate and enhance research of human medicines, led an assessment of digital health in pharmacovigilance focused on the global regulatory landscape. This was achieved through first identifying and forming a glossary of applicable terminology and compiling an index of related regulations, guidelines, and source materials from global health authorities. Using this information, a regulatory landscape assessment was performed, and an industry survey designed. Both outputs indicated that the use of DHTs in pharmacovigilance applications in the pharmaceutical industry is in early development stages for both regulations and real-world utilization. This insight led TransCelerate to develop a tool that would enable a robust exploration of individual DHTs used in the post approval setting through the lens of pharmacovigilance professionals, through proposed considerations for enhancing product safety. This work is intended to positively support the industry in understanding the use and impact of DHTs on pharmacovigilance and readiness. There remains an opportunity to set forth guiding principles and a framework, in collaboration with regulators, healthcare professionals, systems, and patients for DHTs to advance the science of pharmacovigilance.
ICU early mobility improves some patient outcomes, yet practice adoption remains inconsistent owing in part to variable terminology, documentation and measurement. This article describes a decade-long learning health system approach to the study and practice of ICU early mobility measurement, leading to the development of the Out-of-Bed Mobility Eligible Index (OOB-E Index), an automated metric quantifying the frequency of out-of-bed events per mobility-eligible ICU day. Integrated into a mobility dashboard alongside other key metrics, the OOB-E Index supports supports standardized assessment, benchmarking and quality improvement. Measuring the OOB-E Index may enable more effective timing and dosing of ICU mobility.
Vancomycin remains a cornerstone therapy for resistant gram-positive infections, yet adverse drug reactions are common and often mislabeled, leading to unnecessary avoidance and downstream negative consequences. This review summarizes the epidemiology, mechanisms, diagnostic tools, and management strategies to support mechanism-based care. Vancomycin infusion reaction, likely driven by Mas-related G-protein coupled receptor X2, is the most common vancomycin-induced hypersensitivity phenotype, whereas IgE-mediated reactions are rare and remain mechanistically unproven. Diagnostic limitations are substantial, because reactions can be clinically identical and distinguishing biomarkers or diagnostic tools are lacking. Dose-response intradermal testing for vancomycin infusion reaction evaluation is an emerging approach. Vancomycin infusion reaction management focuses on supportive therapy and adjustment of the infusion rate, whereas recurrent or severe reactions should prompt allergy evaluation for a possible IgE-mediated mechanism. Delayed reactions are less well characterized and span a spectrum from benign morbilliform eruptions to severe cutaneous adverse reactions, most notably drug reaction with eosinophilia and systemic symptoms. Diagnostic testing for delayed reactions remains limited, with no validated skin testing methods and in vitro assays restricted to research settings. Continued advances in understanding immunologic mechanisms, together with standardized electronic health record terminology and delabeling pathways, are essential to improve diagnostic accuracy and strengthen antimicrobial stewardship.
What updates of the International Glossary on Infertility and Fertility Care are required, to reflect contemporary scientific knowledge, social needs, and inclusive definitions, while harmonizing international communication across clinical, research, policy, and public domains? This 4th edition presents 348 consensus-based terms and definitions, including numerous revisions from the previous edition and 79 newly introduced definitions reflecting advances in reproductive science, technology, and evolving social contexts. Previous glossary editions (2006, 2009, 2017) established internationally recognized definitions related to clinical practice, research, and policy. The 2017 edition comprised 283 terms and, among many others, expanded the concept of infertility to include not only its recognition as a disease, but also as an impairment of function generating disability. The glossary has been extensively used worldwide and has contributed to international standardization of data collection, appropriate comparison of outcome measures, and provided a reference for all stakeholders including policy makers. Under guidance of the organizing committee, 21 professionals from across the world, and representing expertise in different sub-specialties, formed five working groups: clinical definitions; outcome measures; embryology laboratory; clinical and laboratory andrology; and epidemiology, public health and gender related definitions. The definitions from the previous glossary were evaluated and new terms identified. All definitions were then reviewed by an international advisory panel of nine experts that evaluated the glossary from scientific, ethical, cultural, and policy perspectives. Between November 2024 and October 2025, periodical virtual meetings were held within and between working groups and the organizing committee. Following circulation of the first consensually agreed draft, a one-day in-person meeting with representatives of all working groups and members of the international advisory panel was held at ESHRE, June 2025. Most terms and definitions were discussed and agreed. In the absence of agreement, further discussions were held between the organizing committee, working group chairs and members of the advisory panel. It had been determined at the outset that final disagreement would be resolved via a two-third majority vote. All terms and definitions were, however, reached by consensus and adopted following a final round of review and approval by all authors. The glossary now includes 348 terms. Compared to the previous edition, 14 terms were deleted, numerous terms modified and 79 new terms were added. Modifications reflect current scientific knowledge, technological advancements, and inclusivity related to gender and family structures. Chance does not play a role, as all definitions are consensus-based. Some terms may require future refinement as scientific knowledge evolves and societal contexts change. The glossary reflects consensus rather than empirical testing of all definitions. This glossary provides a global reference for standardized terminology, supporting clinical care, research, international comparisons, policy making, patient communication, and reproductive health literacy. Neither ICMART, responsible for conducting this project, nor any of the participants received specific financial support for their activities in this project. Ferring provided ICMART with a fixed amount to cover venue costs and a one-day hotel accommodation for participants attending the in-person meeting held prior to the ESHRE Congress in June 2025. Disclosures were provided by all authors, and none reported any conflict of interest related to this manuscript. N/A.
Craniofacial wounds present unique management challenges owing to the aesthetic significance of the facial region, proximity to vital structures, risk of contamination from oral flora, and the frequent presence of exposed bone or hardware. Manuka honey, derived from the Leptospermum scoparium plant, possesses well-documented antimicrobial, anti-inflammatory, and wound healing properties attributable primarily to its methylglyoxal content, osmotic activity, and low pH. However, no review has specifically addressed its application in the craniofacial context. A narrative review was conducted using PubMed, Scopus, and Web of Science databases. Search terms combined honey-related keywords with craniofacial and head-and-neck terminology. Clinical studies, case reports, randomized controlled trials, and relevant general wound care reviews were included. The Scale for the Assessment of Narrative Review Articles (SANRA) was used as a quality framework. Evidence supporting the use of Manuka honey in the craniofacial region was identified across several wound categories, including scalp defects with exposed calvarium, head and neck oncologic reconstruction wounds, oral and maxillofacial infections, partial flap necrosis, facial surgical wounds, and burns. In vitro data also suggest selective cytotoxicity against tumor cells, raising the possibility of a dual wound healing and antitumor role in postoncologic surgical wounds. Most available evidence remains at the level of case reports and small series, with only one randomized controlled trial conducted specifically in head and neck wounds. Manuka honey represents a safe, cost-effective, and promising adjunctive wound care modality for the craniofacial surgeon. Registered medical-grade products are ideal where available, but UMF-certified commercial Manuka honey with verified antimicrobial ratings offers a scientifically rational alternative in regions where medical-grade products are not accessible. Prospective studies evaluating Manuka honey in specific craniofacial wound types are warranted.
Central nervous system (CNS)-type tumors may occur in the ovary, often associated with a mature teratomatous component. Because of their rarity, little is known about the tumor types historically designated within the primitive neuroectodermal tumors (PNET) terminology and whether they share histopathological and molecular features akin to those of their CNS counterparts. Herein, we retrospectively investigated data from 13 ovarian tumors, initially diagnosed as either "PNETs" or CNS-type neoplasms. For each tumor we performed comprehensive histopathologic, genetic and epigenetic analyses and retrieved clinical data when available. Integrated diagnoses were established after a central review of histopathological and molecular data, the following entities were identified: four embryonal tumors with multilayered rosettes (non C19MC-altered), three medulloblastomas, SHH-activated, three ependymomas not elsewhere classified, one Ewing sarcoma, one sarcoma, DICER1-mutant, and one peripheral neuroblastoma. Interestingly, none of the ETMRs harbored a C19MC amplification or DICER1 mutation. The three medulloblastomas, SHH-activated were histopathologically and molecularly similar to their CNS counterparts. Ependymomas did not show any classifying molecular alteration and presented a distinct epigenetic profile when compared with CNS ependymomas. These results indicate that ovarian "PNETs" comprise a heterogeneous spectrum of CNS and extra-CNS embryonal or non-embryonal tumor types, and that brain tumor methylation classifiers may be used to classify these tumors. Moreover, these components are characterized by distinct molecular alterations from primary CNS tumors, without C19MC alterations for ETMRs, with an overrepresented SHH-subgroup for medulloblastomas, and with an epigenetic profile distinct from CNS counterparts in ovarian ependymomas. These data need to be confirmed before they can be incorporated into future patient personalized treatment.
Oxaliplatin-induced peripheral neuropathy (OIPN) is a frequent, dose-limiting toxicity in colorectal cancer and markedly impairs quality of life. This study aimed to evaluate the protective role of ketotifen in preventing OIPN, considering its mast-cell stabilizing, histamine H1 receptor-blocking, anti-inflammatory, and analgesic properties demonstrated in preclinical models. In this randomized controlled trial, 64 patients with stage III colorectal cancer were assigned to two groups. The control group (n = 32) received the standard mFOLFOX-6 regimen for 12 cycles, whereas the ketotifen group (n = 32) received the same regimen plus ketotifen 2 mg orally once daily. Neuropathy prevention was assessed through serum biomarkers (neurotensin, superoxide dismutase, interleukin-6), the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE v5.0), the 12-item neurotoxicity questionnaire (Ntx-12), and the Brief Pain Inventory-Short Form (BPI-SF). After 12 cycles, the ketotifen group showed a significant reduction in interleukin-6 and neurotensin levels (p < 0.0001), a lower incidence of grade 2-3 neuropathy (p = 0.001), reduced pain severity (p < 0.0001), and better Ntx-12 scores (p < 0.0001) compared with controls. Ketotifen was well tolerated and improved quality of sleep and appetite (p < 0.0001), addressing additional patient-reported challenges. This trial indicates that ketotifen may offer a promising approach for preventing OIPN. Larger placebo-controlled, double-blind, multicenter trials are needed to confirm these findings. NCT05624138. 1-11-2022. 36030/11/22.
In an increasingly complex clinical setting, long peripheral catheters (LPC) are rapidly gaining popularity and represent an effective option for the administration of medications and fluids, especially for patients with difficult venous access. However, inconsistencies in the literature, particularly regarding terminology and insertion techniques, have contributed to significant variability in clinical outcomes. To standardize and promote a safer and more effective insertion of these catheters, the Italian Group of Long-Term Venous Access Devices (GAVeCeLT) and the Italian Vascular Access Society (IVAS) have developed a six-step protocol that provides evidence-based recommendations. This insertion bundle-named SILPeC (Safe Insertion of Long Peripheral Catheters-includes (1) pre-insertion assessment of the vein of the upper limbs, (2) insertion of the optimal site selection, (3) appropriate measures of asepsis, (4) ultrasound-guided puncture, (5) safe connection to infusion lines, and (6) proper device stabilization and appropriate protection of the exit site. Integrating the latest scientific evidence and clinical expertise, the SILPeC bundle provides a standardized and reproducible method for placement and maintenance of LPCs. This project complements the existing GAVeCeLT recommendations for other vascular access devices, contributing to safer and more consistent vascular access practices in both hospital and outpatient settings.
Chemotherapy-induced peripheral neurotoxicity (CIPN) is the most common neurologic complication of cancer treatment. Sarcopenia, characterized by muscle mass loss, has been associated with treatment-related toxicity, but its association with CIPN remains unclear. We aimed to assess the association of pretreatment sarcopenia with the development of CIPN. A single-center, prospective observational study at the Hospital Universitari de Bellvitge-Institut Català d'Oncologia was conducted on patients with cancer scheduled to receive brentuximab vedotin (BV), oxaliplatin (OXA), or paclitaxel (PTX). A pretreatment CT or PET-CT (≤30 days) was required. Sarcopenia was assessed using the skeletal muscle index at the third lumbar vertebra. Patients were evaluated before (T0) and after (T1) chemotherapy treatment. All patients were assessed using the Total Neuropathy Score-clinical version (TNSc) and Common Terminology Criteria for Adverse Events (CTCAE) at T0 and T1. Nerve conduction studies (NCS) and blood measurements (neurofilament [NfL], myostatin, and albumin) were conducted at the same time points. Clinically relevant (CR) CIPN was defined as CTCAE grade ≥2. Associations were analyzed using multivariate logistic regression. A total of 105 patients (47.6% female; median age 55 years) were studied. Before treatment (T0), 47.6% of patients had sarcopenia. CIPN occurred in 84.7% of patients, with CR-CIPN observed in 39% (33.3% grade 2; 5.7% grade 3). At T1, NfL and TNSc scores increased significantly, while distal sensory and motor NCS amplitudes decreased. Sarcopenia was more common in patients developing CR-CIPN (61.9% vs 38.1%; p = 0.028). Multivariate analysis identified sarcopenia as an independent risk factor of CR-CIPN (odds ratio [OR] 2.5; 95% CI 1.07-5.83; p = 0.033), and patients receiving microtubule-based agents-PTX (OR 0.17, 95% CI 0.03-0.92, p = 0.04) or BV (OR 0.37, 95% CI 0.15-0.90, p = 0.027)-had lower odds of CR-CIPN compared with those receiving OXA. Pretreatment sarcopenia is associated with 2.5-fold higher odds of moderate-to-severe CIPN. Assessing sarcopenia using routine prechemotherapy imaging techniques can help identify individuals at higher risk of CR-CIPN.