COVID-19 cluster outbreaks and infection control measures in nursing homes in Okinawa: protocol for a retrospective observational study

Abstract: Following the reclassification of COVID-19 as a category V infectious disease in Japan in May 2023, systematic public health monitoring of case numbers and cluster outbreaks was discontinued. Consequently, infection control measures, responses to cluster outbreaks and vaccination coverage in long-term care facilities were largely left to the discretion of individual facilities, and the understanding of the current situation in these settings remains insufficient. This observational study aims to retrospectively investigate COVID-19 cluster outbreaks and the resulting burdens experienced by facilities after reclassification, focusing on special nursing homes (Tokubetsu Yogo Rojin Home) for older adults, a population at particularly high risk for COVID-19-associated hospitalisation and mortality. By comprehensively evaluating facility and resident characteristics, vaccination coverage and infection prevention and control measures, this study seeks to generate evidence to inform future infection control strategies in long-term care facilities. This retrospective observational study targets special nursing homes in Okinawa Prefecture and residents living in these facilities. Data for a target sample of nine nursing homes with approximately 900 residents will be collected from existing facility and medical records using the Research Electronic Data Capture system. The study was initiated in June 2025 and completion is anticipated by March 2027. The primary outcomes are the occurrence of COVID-19 cluster outbreaks in nursing homes between May 2023 and August 2025 and the facility-level burden experienced during outbreaks, including operational and economic impacts. A cluster outbreak is defined as the occurrence of ≥2 cases of the same infectious disease within a 10-day period. Key variables of interest include baseline characteristics of facilities and residents, vaccination coverage among staff and residents and infection prevention and control measures. Additionally, the study explores potential factors associated with residents' clinical outcomes and facility burden using logistic and linear regression models, respectively, with facility-level random intercepts if deemed appropriate. Prespecified supplementary analyses include one-way analysis of variance and χ2 tests. The study protocol was approved by the Institutional Review Board of the University of the Ryukyus in June 2025 (approval number: 25-2486-00-00-00). The findings will be disseminated at academic conferences and in peer-reviewed medical journals.

Ideguchi S
Takayama Y
Ikemiyagi N
Ujimiya F
Yamaniha K
Imura M
Tanabe K
Yamamoto K

Humans
Japan
Nursing Homes
Retrospective Studies
Infection Control
COVID-19
Disease Outbreaks
SARS-CoV-2
Nursing Home Residents
Aged


[Clinical practice guidelines "Congenital adrenal hyperplasia in children" with comments]

Abstract: The clinical practice guidelines for congenital adrenal hyperplasia (CAH) in children clearly and systematically present the key information on the epidemiology, etiology, pathogenesis, and diagnostic methods for all forms of the disease. Protocols for glucocorticoid and mineralocorticoid replacement therapy, as well as follow-up regimens for patients in different age groups, are provided. These clinical guidelines were developed and approved by the expert community of pediatric endocrinologists from the Russian Association of Endocrinologists and endorsed by the council of the Russian Federation Ministry of Health. The guidelines are based on systematic reviews, meta-analyses, original articles, and scientific studies on this pathology conducted in the Russian Federation and other countries. This article provides updated author comments and clarifications on the most critical aspects of the diagnosis and treatment of congenital adrenal hyperplasia in childhood.

Chugunov IS
Kopylova IV
Kolodkina AA
Kalinchenko NY
Vorontsova MV
Bezlepkina OB
Peterkova VA
Mokrysheva NG

Humans
Adrenal Hyperplasia, Congenital
Child
Glucocorticoids
Russia
Practice Guidelines as Topic
Mineralocorticoids

Journal Article
English Abstract
Practice Guideline


AGA Clinical Practice Update on Surveillance of Metaplastic and Premalignant Conditions of the Esophagus and Colorectum in Older Adults: Expert Review

Abstract: The United States Census Bureau projects that the population of Americans ≥65 years old will grow 5 times faster than the total population, reaching 82 million by 2050 (23% of the population). Health care providers will increasingly need to discuss the cessation of cancer screening due to limited value in patients whose age or comorbidities preclude time to benefit from eradication of preneoplastic lesions. Although evidence supports colonoscopy's ability to reduce population-wide colorectal cancer mortality, high-quality data around endoscopic surveillance of Barrett's esophagus is more limited. In this Clinical Practice Update, we review practical approaches to assess appropriateness for colorectal cancer and esophageal cancer surveillance, the real-world yield of screening and/or surveillance in older adults, and the potential harms of surveillance. This expert review was commissioned and approved by the American Gastroenterological Association Institute Clinical Practice Updates Committee and the American Gastroenterological Association Governing Board to provide timely guidance on a topic of high clinical importance to the American Gastroenterological Association membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. BEST PRACTICE ADVICE STATEMENTS BEST PRACTICE ADVICE 1: Formal determination of comorbidities and use of life expectancy tools may help differentiate among older adults most likely to benefit vs those most likely to be harmed by surveillance. Real-world effectiveness and cost-effectiveness analysis in diverse populations would help with widespread implementation. BEST PRACTICE ADVICE 2: The goal of endoscopic surveillance in Barrett's esophagus is to detect dysplasia and adenocarcinoma at an early and treatable stage. Endoscopic surveillance of Barrett's esophagus should follow current best practices in terms of imaging, tissue acquisition, and surveillance intervals. BEST PRACTICE ADVICE 3: The choice to continue endoscopic surveillance of Barrett's esophagus should be based on shared decision-making that examines factors such as comorbidities, life expectancy, risks, and benefits, as well as patient preferences. BEST PRACTICE ADVICE 4: Utilization of tools for prediction of dysplasia progression in Barrett's esophagus may help contextualize the time frame for the development of adenocarcinoma within an individual's life expectancy. BEST PRACTICE ADVICE 5: Inability to tolerate endoscopic therapy, surgery, or oncologic interventions for esophageal adenocarcinoma should lead to cessation of Barrett's esophagus surveillance regardless of age. BEST PRACTICE ADVICE 6: The decision to continue colorectal cancer screening in individuals >75 years old should be individualized, based on an assessment of benefits, screening history, comorbidities, and risks. BEST PRACTICE ADVICE 7: The decision to continue surveillance of colorectal polyps in individuals >75 years old should be individualized, based on an assessment of benefits, polyp history, comorbidities, and risks. BEST PRACTICE ADVICE 8: With increasing age, colonoscopy is associated with a higher incidence of adverse events regardless of the indication. Therefore, the clinical decision-making process for colonoscopy should be clearly documented in the electronic health record for individuals >75 years. BEST PRACTICE ADVICE 9: Whenever possible, published studies of the use, effectiveness, deimplementation, and costs of colonoscopy in older adults should be used to inform practice decisions for patients and clinicians.

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association


Clinical Practice Guideline on the Pharmacological Management of Antipsychotic-Related Dyslipidemia

Abstract: People taking antipsychotic medicines and those with severe mental illness experience elevated cardiovascular risk compared to the general population which is not adequately addressed by existing guidelines. Increases in lipid levels can occur soon after starting antipsychotics but often go untreated. Cumulative exposure to dyslipidemia from childhood, through young adulthood, facilitates atherogenesis. Regression of early lesions is possible; however, plaque progression can be irreversible, leading to sustained long-term cardiovascular risk. Although lipid-lowering therapies are effective at lowering cardiovascular risk, they are underutilized in this population. We have thus developed a clinical practice guideline for the pharmacological management of antipsychotic-related dyslipidemia. Using GRADE-ADOLOPMENT methodology, an international, multidisciplinary panel including experts-by-experience, developed a guideline for the pharmacological management of antipsychotic-related dyslipidemia. Literature was reviewed to answer key health questions. Patient important outcomes were identified. An evidence-to-decision framework informed the strength of recommendations and external reviews evaluated the rigor of the methods. Seven recommendations were developed on how and when to initiate lipid-lowering therapy based on specific criteria including established cardiovascular disease/high-risk conditions, cardiovascular risk assessment, or lipid parameter thresholds. A guideline algorithm illustrates the recommendations alongside supporting prescribing information. This is the first clinical practice guideline for the management of antipsychotic-related dyslipidemia. The inclusion of recommendations for individuals aged 10 years and over represents a significant development. Implementation will be supported by shared decision-making resources including information videos and decision-aids.

Carolan A
Hynes-Ryan C
Bourke R
Columb D
Cullen W
deFerranti S
Harrington SM
Kelleher I
Kennedy C
Khoury M
Lally J
Lyne J
Norton M
O'Connor K
O'Connor P
O'Shea D
Perry B
Prendeville T
Ryan C
Sadowska E
Shiers D
Siskind D
Strawbridge J
Tae H
Keating D
O'Donoghue B

Humans
Dyslipidemias
Antipsychotic Agents
Hypolipidemic Agents
Practice Guidelines as Topic
Cardiovascular Diseases
Schizophrenia


Designing the Home Environment to Support Aging in Place for Individuals With Intellectual and Developmental Disabilities

Archives of physical medicine and rehabilitation

Murphy E
Nielsen B
Smith K
Flanagan S
Carrillo S
Magasi S


Recommendations of the Brazilian Society of Nephrology for sustainable nephrology in Brazil

Abstract: Climate change has increased the vulnerability of patients with non-dialysis chronic kidney disease (CKD) and those receiving kidney replacement therapy (KRT), who depend on healthcare systems that are highly sensitive to disruptions in electricity, potable water supply, and logistics. At the same time, KRT services are among those with the greatest environmental impact within the healthcare sector, characterized by high water and energy consumption and substantial generation of solid waste. In this context, the incorporation of sustainable practices has become an ethical, clinical, and strategic imperative. In 2023, the Brazilian Society of Nephrology (SBN) established the Committee on Sustainable Nephrology with the objective of developing national guidelines to reduce the environmental impact of kidney care services. After two years of work, the Committee developed ten recommendations structured across key domains, including education, environ-mental indicator monitoring, waste management, efficient use of resources, climate contingency planning, promotion of prevention and kidney transplantation, technological innovation, and sustainability certifications. These recommendations were discussed and approved at the 2nd Convention of the SBN Board of Directors and its Regional Chapters, achieving a 98.5% level of agreement. This document presents the consolidated recommendations, with the aim of supporting the implemen-tation of sustainable practices in kidney care services across the country and pro-moting an environmentally responsible, efficient nephrology practice aligned with the emerging challenges posed by climate change.

Moura AF
Vieira CKS
Pimentel AL
Pinto LCS
Nerbass FB
Tostes FRV
Riso NDM
Trancoso RB
Salani TG
Costa CBS
Abreu PF
Moura-Neto JA

Brazil
Nephrology
Humans
Societies, Medical
Conservation of Natural Resources
Climate Change


[Guideline for diagnosis, treatment and prevention of type 1 diabetes mellitus in children(2026)]

Zhonghua er ke za zhi = Chinese journal of pediatrics

Subspecialty Group of Endocrinology, Hereditary and Metabolic Diseases, the Society of Pediatrics, Chinese Medical Association

Editorial Board, Chinese Journal of Pediatrics

Humans
Diabetes Mellitus, Type 1
Child
Early Diagnosis
Quality of Life
Mass Screening


Improving follow-up of abnormal stool test results used for colorectal cancer screening

Abstract: Stool tests are an essential component of colorectal cancer (CRC) screening. Patients with positive test results are at increased risk of CRC, and a timely follow-up with colonoscopy is recommended. Follow-up colonoscopy rates remain suboptimal. The current article reviews the barriers to timely colonoscopy, highlights evidence-based interventions, and provides actionable recommendations for endoscopists, health systems, and policymakers. By implementing coordinated strategies, including patient navigation, digital tools, and open access colonoscopy, health care organizations can close critical gaps in the CRC screening continuum and decrease CRC incidence and mortality.

Levin TR
Ciemins E
Dominitz J
Hosseini-Carroll P
Issaka RB
Lieberman D
Merriman N
Shaukat A
Stollman N
Williams KN


Consensus document on the management of patients with accidental hypothermia from the Spanish Society of Anesthesiology, Resuscitation and Pain Management (SEDAR), the Spanish Society of Intensive Care Medicine, Critical Care and Coronary Units (SEMICYUC), and the Spanish Society of Emergency Medicine (SEMES)

Abstract: Accidental hypothermia is an underdiagnosed condition with a significant impact on public health. With the aim of providing the basis for a comprehensive care framework, 12 panelists from 3 Spanish scientific societies (SEDAR, SEMES and SEMICYUC) developed this multidisciplinary consensus document. Through a systematic search and the final synthesis of 281 articles including 1,704,632 patients, 37 recommendations were developed through a 2-round Delphi process, distributed across 8 application domains based on the organization of a rescue chain: prehospital prevention, initial evaluation, management and transport, hospital detection, care of the polytraumatized patient, hospital rewarming, cardiac arrest, and resuscitation. Robust consensus among panelists (>75% agreement) and excellent internal consistency (ω = 0.913) were achieved, providing a solid document that may serve as a basis for the implementation of standardized protocols.

Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias

Blasco Mariño R
Argudo E
Soteras Martínez I
Avellanas Chavala ML
Pons Claramonte M
Rius J
Martín Sánchez L
Pinillos Alonso A
González-Delgado D
Barea Mendoza JA
Fernandez CP
Laurens Acevedo M

Humans
Hypothermia
Spain
Emergency Medical Services
Critical Care
Rewarming
Cardiopulmonary Resuscitation
Heart Arrest
Delphi Technique
Resuscitation
Societies, Medical

Journal Article
Consensus Statement
Practice Guideline


European PKU guidelines at a glance: infographics summarising key recommendations

van Wegberg AMJ
MacDonald A
Giżewska M
Ahring K
Lange E
Hagedorn T
Hammerschmidt G
Henek M
van Spronsen FJ


Closing the completion colonoscopy gap: key takeaways from the American Society for Gastrointestinal Endoscopy's 2025 National Colorectal Cancer Screening Summit

Hosseini-Carroll P
Dominitz JA
Jacobson BC
May FP
Issaka RB
Schmitt CM
Adams TL
Boston IJ
Bucobo JC
Day L
Khaykis IB
Marino MJ
Rex DK
Sun E
Wynter JA
Christie JA


The Society of Thoracic Surgeons / World Society for Pediatric and Congenital Heart Surgery / European Congenital Heart Surgeons Association 2026 Expert Consensus Document on Timing, Indications, and Options for Pulmonary Valve Replacement in Children with Repaired Tetralogy of Fallot

Abstract: Contemporary surgical and medical management has enabled excellent long-term survival and quality of life for children following repair of tetralogy of Fallot. However, most patients are left with residual pulmonary regurgitation that requires long-term surveillance and eventual pulmonary valve replacement to prevent right ventricular failure. Guidelines have been developed regarding the indications for and timing of pulmonary valve replacement in adults, but such do not exist for children. This expert consensus document aimed to address those gaps by supporting clinical decision-making regarding the surgical and transcatheter management of chronic pulmonary regurgitation in children with repaired tetralogy of Fallot. The Society of Thoracic Surgeons Workforce on Evidence Based Surgery assembled a multidisciplinary expert panel composed of congenital surgeons and cardiologists. A focused literature review was performed, and expert consensus statements were developed using a Modified Delphi process and clustered under two key topics: (1) pediatric-specific considerations and (2) surgical versus transcatheter techniques. Consensus was reached for 13 recommendations. The recommendation statements reflect contemporary expert opinion on the timing and decision-making for pulmonary valve replacement in children. While decision-making regarding the management of chronic pulmonary regurgitation after repair of tetralogy of Fallot in children is complex, this document provides guidance for congenital heart teams to optimize management based on a synthesis of contemporary evidence.

Stephens EH
Zampi JD
Sarris GE
Protopapas E
Zanaboni DB
Taggart NW
Lotto AA
Rossi CS
Kamp A
Sood P
St Louis JD
Jacobs JP
Nelson JS


[Comprehensive cardiovascular prevention: the role of vaccination in older adults with cardiovascular disease. Expert consensus document]

Abstract: Respiratory and systemic infections can trigger cardiovascular events by increasing inflammation, atherosclerotic plaque instability, and a prothrombotic state. Given this situation, vaccination is a relevant preventive tool in patients with cardiovascular disease (CVD). To review the available evidence on the impact of vaccination in patients with CVD and to propose recommendations to improve vaccination coverage in clinical practice. This expert consensus, developed through a structured narrative review and panel discussion rounds, synthesizes the evidence on vaccination against influenza, pneumococcal disease, respiratory syncytial virus (RSV) infection, COVID-19, and herpes zoster in patients with CVD. The influenza vaccine presents the strongest evidence for reducing cardiovascular events, especially after acute episodes and in high-risk patients. For vaccination against pneumococcal disease, COVID-19, RSV infection, and herpes zoster, although direct cardiovascular evidence is more limited, the reduction in infections and hospitalizations supports its recommendation for a comprehensive preventive approach. Vaccination is part of a comprehensive cardiovascular prevention approach. Improved coverage, supported by shared pathways between cardiology and primary care, along with public health services, can result in fewer infectious complications, fewer cardiovascular decompensations, and better clinical outcomes.

Bonanad C
Alfaro R
Morán Bayón Á
Cainzos-Achirica M
García-Lledó A
Raposeiras-Roubín S
Vivas D
Freixa-Pamias R
Mora J
Martín-Toro MA
Fernández-Olmo R
Maidana D
Barreres-Martín G
Barrios V
Redondo E

English Abstract
Journal Article
Practice Guideline


Singapore First Aid Guidelines 2026

Abstract: First aid is the immediate care provided for acute illness or injury and can be initiated by anyone in any situation. Its aims are the preservation of life, alleviation of suffering, prevention of further harm and promotion of recovery. To reflect evolving medical science surrounding first aid, the standards of care by first aiders must also evolve accordingly. The Singapore Resuscitation and First Aid Council has updated the national practice standards with the publication of the Singapore First Aid Guidelines 2026. The current guidelines incorporate the latest international evidence synthesis while prioritising relevance for Singapore's first aid training and operational context. The existing guidelines remain relevant unless specifically updated. The main additions and significant revisions in this edition include guidance on pulse oximeters, bronchodilators, supplementary oxygen, repeated doses of adrenaline in anaphylaxis, hypoglycaemia correction, physical counterpressure manoeuvres for presyncope, handling of amputated body parts, rehydration for exertional-related dehydration and treatment of jellyfish stings.

Humans
First Aid
Singapore
Anaphylaxis
Epinephrine
Fluid Therapy
Resuscitation
Dehydration
Bronchodilator Agents


Abstract: Effective neonatal resuscitation demands coordinated teamwork following standardised algorithms and guidelines to ensure successful transition to extrauterine life. As guidelines evolve with emerging evidence, regular review and adherence to updated recommendations are crucial for optimal patient outcomes. We present the revised Singapore Neonatal Resuscitation Guidelines 2026. The recent 2025 recommendations from the International Liaison Committee on Resuscitation Neonatal Task Force's Consensus on Science and Treatment Recommendations, together with guidelines from the American Heart Association and the European Resuscitation Council, were compared with the existing guidelines. The recommendations of the Neonatal Subgroup of the Singapore Resuscitation and First Aid Council were formulated following the workgroup's critical discussion and appraisal of the currently available evidence, with careful consideration of its relevance and applicability to local clinical practice.

Kong JY
Kader KBA
Baral VR
Arunachalam S
Buvaneswarran S
Chinnadurai A
Tong WY
Yip WY
Ee KTT
Yeo CL
Biswas A
Ho SKY
Quek BH

Humans
Singapore
Infant, Newborn
Resuscitation
Practice Guidelines as Topic
Algorithms
Cardiopulmonary Resuscitation


Abstract: The Singapore Paediatric Life Support Guidelines 2026 updates the 2021 guidelines and provides evidence-based, consensus recommendations for life support in paediatric patients (<18 years of age), excluding newborns. We reviewed treatment recommendations from the International Liaison Committee on Resuscitation Paediatric Life Support Task Force as well as resuscitation guidelines from the American Heart Association, the European Resuscitation Council and other relevant studies and reviews published between January 2021 and January 2026 to inform these paediatric life support guidelines. This clinical practice guideline adopts an evidence-based and patient-centred approach to the life support of paediatric patients in Singapore. Recommendations were updated following deliberation of peer-reviewed evidence updates on paediatric resuscitation, with consideration of local context, resources and clinical practice.

Paediatric Subcommittee 2023–2027, Singapore Resuscitation and First Aid Council

Humans
Singapore
Child
Life Support Care
Pediatrics
Resuscitation
Practice Guidelines as Topic
Infant
Adolescent
Infant, Newborn
Cardiopulmonary Resuscitation
Child, Preschool


Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026

Abstract: An updated clinical practice guideline on total knee arthroplasty, initially published in 2020, was developed by an American Physical Therapy Association volunteer guideline development group consisting of physical therapists, an orthopedic surgeon, and an occupational therapist. The guideline was based on a systematic review of current scientific literature. Twenty recommendations were formulated. Benefits, harms, feasibility, and role of patient preferences in implementing these recommendations were identified. Recommendations identified current gaps in knowledge and future areas of needed research.

Bove AM
Carroll LA
Cone S
Dibblee P
Hensley CP
Lenington K
Manner PA
Scalzitti DA
Tompkins J
Bade MJ

Humans
Arthroplasty, Replacement, Knee
Physical Therapy Modalities


[Guidelines for the management of traumatic brain injury in the maritime environment (2026 edition)]

Abstract: The management of traumatic brain injury (TBI) in maritime settings faces multiple challenges, including significant disparities in medical platform capabilities compared to land-based systems, spatial constraints and persistent vessel motion, limitations in power supply, oxygen, and consumables, unstable conditions for monitoring and imaging, evacuation influenced by sea-state windows, and difficulties in inter-platform handovers. These factors lead to a significantly increased risk of preventable secondary brain injury. To standardize the early treatment and transportation management of patients with TBI in maritime environments, and to enhance the continuity and operability of the maritime treatment chain, Guidelines for the management of traumatic brain injury in the maritime environment (2026 edition) was developed by experts convened under the leadership of the Neurosurgery Specialist Alliance of the Joint Logistics Support Force, in collaboration with the Neurotrauma Society of the China International Exchange and Promotive Association for Medical and Health Care, Neurotrauma Group of the Chinese Congress of Neurological Surgeons, and Craniocerebral Trauma Panel of the Neurosurgery Society of the Beijing Medical Association. With the core principles of "reducing secondary brain injury and ensuring continuity of care", this guideline synthesizes relevant domestic and international guidelines along with practical experience from resource-limited or delayed evacuation scenarios. Utilizing a grading system for evidence quality (A, B, C, D) and recommendation strength (strong recommendation, weak recommendation, conditional strong recommendation), it provides 25 recommendations focusing on: on-scene management and triage upgrade; tiered decision-making under conditions of limited imaging and monitoring; platform capability classification and evacuation pathways; minimum en-route monitoring configurations; and specific risk management for the maritime environment. This guideline aims to provide an executable, verifiable, transferable, and trainable standardized management framework for maritime TBI patients, offering a reference for clinical decision-making on various maritime medical platforms and evacuation nodes.


[PANCCO Clinical Practice Guideline Update for the treatment of ulcerative colitis in adults]

Abstract: To update the recommendations of the Pan American Crohn's and Colitis Organisation (PANCCO) for the treatment of moderate-to-severe ulcerative colitis (UC) in adults, incorporating recent evidence on new biologics, small molecules, subcutaneous formulations and appendectomy. The PAHO rapid GRADE methods were applied. PANCCO adapted the Colombian guideline 2025 for upadacitinib, tofacitinib, ozanimod and the switch to subcutaneous formulations, and developed de novo recommendations for etrasimod, guselkumab, risankizumab, ustekinumab, mirikizumab, filgotinib and appendectomy. The search was carried out in MEDLINE, Embase, Cochrane and Epistemonikos through February 2026, with quality appraised with ROBIS, AMSTAR-2, RoB 2.0 and ICEMAN; strength of recommendations was established using GRADE. Recommendations were issued for nine clinical questions. In moderate-to-severe UC, upadacitinib, tofacitinib, filgotinib, ustekinumab, mirikizumab, risankizumab and guselkumab are recommended; ozanimod and etrasimod are conditionally suggested, considering the cardiovascular profile. In patients with response to intravenous induction, switching to subcutaneous vedolizumab or subcutaneous infliximab is suggested. In UC refractory to advanced therapies, laparoscopic appendectomy is conditionally suggested as an adjuvant strategy. This third update expands the therapeutic armamentarium for moderate-to-severe UC in Latin America. Treatment choice should be individualized according to prior therapy, comorbidities, cardiovascular and thrombotic risk, availability and patient preferences.

Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru

Núñez Figueroa P
Sánchez Orozco A
Alfaro Pérez I
Andara Ramírez MT
Balderramo D
Bautista S
Cassella F
Cervera Caballero LA
De León Rendón JL
De Lucas Ocaña J
García Vilela E
Jara Alba ML
Linares Serrano M
Martínez-Vázquez MA
Morínigo Bogado SD
Muñoz Camacho R
Parra-Izquierdo V
Pérez Baldíoceda J
Puentes-Manosalva FE
Rodríguez Olaso X
Saad-Hossne R
Serrano M
Suarez M
Umaña Solis E
Pardo-Turriago R
Yuseff S
Lozano T
Juliao-Baños F

Humans
Colitis, Ulcerative
Adult
Severity of Illness Index

Journal Article
Practice Guideline
English Abstract


[Evidence-Based Guidelines for the Diagnosis and Treatment of Helicobacter pylori Infection in Korea: 2025 Revised Edition]

Abstract: Since the 2020 Korean guidelines for Helicobacter pylori treatment, clarithromycin resistance rates have risen from 17.8% to 33.3%, dual-priming oligonucleotide-based polymerase chain reaction-guided tailored therapy has been adopted, and potassium-competitive acid blockers (P-CABs) have become available. This fourth revision addressed these changes. Nine key questions were addressed through systematic review and meta-analysis. Thirteen recommendations were evaluated using a modified Delphi process involving 64 experts. Twelve recommendations achieved a first-round consensus; one required revision and achieved 73.9% agreement. Key changes included: 1) a dual-pillar strategy of tailored therapy and empirical quadruple therapy; 2) restricted use of empirical clarithromycin- based triple therapy under specific conditions; 3) removal of sequential therapy; 4) use of P-CABs as alternatives to proton pump inhibitors; 5) expansion of eradication indications to include gastric cancer prevention in H. pylori gastritis and regression of hyperplastic polyps ≤10 mm; and 6) positioning of bismuth quadruple therapy as a conditionally recommended first-line empirical option, with preference for reservation as salvage therapy, and introduction of modified bismuth quadruple therapy (addition of bismuth to conventional regimens) as an additional first-line empirical option. The revised guidelines provide updated evidence-based recommendations for the diagnosis and treatment of H. pylori infection, reflecting the rapidly changing antibiotic resistance landscape and the introduction of new diagnostic and therapeutic tools in Korea. These guidelines aim to assist clinicians, patients, policymakers, and medical educators in optimizing H. pylori management. They may differ from the current medical insurance standards and will be further revised based on emerging evidence.

The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi

Korean College of Helicobacter and Upper Gastrointestinal Research

Humans
Helicobacter Infections
Helicobacter pylori
Anti-Bacterial Agents
Proton Pump Inhibitors
Republic of Korea
Clarithromycin
Drug Resistance, Bacterial
Drug Therapy, Combination


[GFCO national recommendations on the use of liquid biopsy for circulating tumor DNA analysis in oncology]

Abstract: The analysis of circulating tumor DNA (ctDNA) by liquid biopsy is a major advance in the management of patients with cancer, offering a minimally invasive method for detecting tumor genetic alterations and enabling personalized monitoring. Faced with complex technological challenges and the need for rigorous validation, the French-Speaking Group for Oncological Cytogenomics (GFCO) has established national consensus guidelines. These guidelines, designed to govern ctDNA analysis, were developed using the Delphi consensus methodology. A questionnaire developed by a working group of eight biologists and two bioinformaticians was submitted to 55 French platforms specializing in liquid biopsy in oncology. A participation rate of 71% was achieved. Consensus was defined by an agreement threshold of at least 80%. A live discussion and voting session was held during the GFCO 2024 Days for items that did not initially reach this threshold. The validated recommendations cover the pre-analytical, analytical, and post-analytical phases. In total, 37 recommendations with a consensus exceeding 80% were adopted. These GFCO recommendations provide a standardized framework for the use of liquid biopsy in oncology in France. Regular updates will be necessary to adapt to the rapid evolution of the technology.

pour le Groupe de travail du Groupe français de cytogénétique oncologique (GFCO)


Rapid Endovascular Hemorrhage Control in Trauma: a Joint Position Statement from the American College of Surgeons Committee on Trauma and the Society of Interventional Radiology

Abstract: Timely hemorrhage control is a critical determinant of survival after traumatic injury. Advances in endovascular techniques have expanded the role of interventional radiology, making it an essential component of contemporary trauma care. This position statement affirms the importance of rapid hemorrhage control, emphasizes the role of interventional radiologists as integral members of multidisciplinary trauma teams, and clarifies expectations related to the American College of Surgeons Verification, Review, and Consultation (VRC) Program standards for interventional radiology resources and availability. It also provides guidance for trauma centers to optimize institutional processes and coordination between trauma surgery and interventional radiology to ensure timely and effective hemorrhage control for injured patients.

Journal of vascular and interventional radiology : JVIR

Wilkins LR
Perlstein J
Miller MJ
Padia SA
Sagraves S
Shah RP
D'Onofrio LJ
Nathens AB


How to optimise prostate SBRT: ESTRO clinical practice consensus recommendations

Abstract: A steady rise in the number of patients receiving stereotactic body radiation therapy (SBRT) for primary prostate cancer is expected. Consequently, the current European Society for Radiotherapy and Oncology (ESTRO) 'how to' consensus has been developed to offer practical recommendations for the initiation and implementation of prostate SBRT in radiotherapy (RT) departments. A panel of fifteen experts in the field of prostate SBRT reviewed and analysed the literature and, through a Delphi process, answered a ten-item questionnaire addressing areas of controversy in prostate SBRT. Consensus was a priori defined as ≥75% agreement in each answer, while ≥90% agreement was defined as strong consensus. The aim of this 'how to' consensus recommendations is to define minimum requirements, common practices and additional options for prostate SBRT based on scientific evidence, expert opinion and consensus. This 'how to' clinical practice recommendations cover patient selection and follow-up process, treatment planning and delivery techniques in prostate SBRT.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

Draulans C
Tree A
Zilli T
Alongi F
Zamboglou C
Ost P
Jereczek-Fossa BA
Blanchard P
Gomez-Iturriaga A
Faccenda V
Wolf F
Roover R
Scherman J
Alexander S
Schmidt-Hegemann NS


French guidelines for the diagnosis and management of neuromyelitis optica spectrum disorder

Abstract: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system, characterized by severe attacks. Optic neuritis is the most common clinical manifestation, leading to a rapid and often severe loss of vision, which is sometimes bilateral, with frequent sequelae and a risk of very low visual acuity in the long-term. Magnetic resonance imaging (MRI) reveals extensive lesions of the optic nerve, mostly involving the posterior part of the nerve and sometimes extending to the optic chiasm. Myelitis manifests as longitudinally extensive and centrally located spinal cord lesions, which may lead to tetraplegia, sensory disturbances, neuropathic pain and sphincter dysfunction. Area postrema syndrome presents with nausea, vomiting, and severe hiccups, which are often resistant to conventional treatments and may require hospitalization. Diagnosis is confirmed by the detection of anti-aquaporine 4 (AQP4) antibodies in the serum. Attacks should be treated as an emergency, with intravenous (IV) corticosteroids and plasma exchange, without waiting for antibody confirmation. Maintenance therapy includes monoclonal antibodies targeting B lymphocytes, interleukin-6 receptor, complement C5 and non-selective immunosuppressive treatments, according to profile of tolerance. Conventional treatments such as azathioprine or mycophenolate are less commonly used as first-line therapies but remain possible depending on the clinical context. Follow-up is multidisciplinary, with neurological, and according to the symptoms ophthalmological, neuropsychological, urodynamic or sequellar disability consultations. Therapeutic patient education and support from patient organizations are essential for improving quality of life and treatment adherence. Pregnancy is considered high-risk, requiring regular neurological and obstetric monitoring, as the risk of attack increases in the postpartum period. Finally, the rapid and individualized management of attacks as well as the prevention of relapses is crucial to limit functional sequelae and disability.

Giorgi L
Marignier R
Pique J
Maurey H
Papeix C
Ciron J
Collongues N
Cheuret E
Zephir H
Meyer P
Vukusic S
Doret-Dion M
AbiWarde MT
Nguyen The Tich S
Bourre B
Audoin B
Pouget MC
Yver E
Lattaud C
Froment Tilikete C
De Sèze J
Debroise AC
Gelé M
Mamoudjy N
Cleuziou P
Maillart E
Deiva K
MIRCEM network


French guidelines for post-polio syndrome and management of effects of aging in people with sequelae of acute anterior poliomyelitis

Abstract: People with sequelae of acute anterior poliomyelitis (AAP) may develop secondary complications related to aging, as well as a specific complication of the disease known as post-polio syndrome (PPS). These complications are new neurological and musculoskeletal manifestations that occur after a prolonged period of disease stability. The onset is typically insidious and slow, but can be more rapid following a period of immobilization, surgery, or another intercurrent condition. The initial assessment may involve consulting a neurologist to rule out neurological diagnoses. Electroneuromyographic examination is a valuable tool for evaluating these patients. It is sometimes difficult to differentiate between the effects of aging in a person with sequelae of AAP and PPS, which is a distinct entity with specific diagnostic criteria. The rate at which muscle capacity declines, and its functional impact, can be a distinguishing factor. Subacute or rapid onset can be indicative of PPS. The emergence of new motor deficits in areas that were previously unaffected is also a strong argument for PPS. This neurological deterioration must be distinguished from musculoskeletal disorders associated with aging. Progression is usually slow and gradual, or occurs in stages with periods of stabilization. Physical and rehabilitation care is essential both in the initial assessment and for ongoing follow-up. There are no recommended medicinal treatments, especially no specific etiological treatment for PPS (such as immunoglobulins, corticosteroids, etc.) or effective symptomatic treatment for manifestations like fatigue or muscle weakness (e.g., pyridostigmine). Pain management should be regularly assessed; while drug treatments are not specific, non-pharmacological pain management through physical therapy is crucial. Particular attention should be paid to comorbidities, including excess weight and an increased risk of osteoporosis and fractures. Management should be multidisciplinary, with an annual review recommended. Follow-up will be adjusted based on the patient's preferences and needs, and monitoring will depend on the development of complications.

Verschueren A
Cotinat M
Roseau JB
Thefenne L
French PPS working Group


Obstructive Sleep Apnea (OSA) in Pregnancy - An American College of Chest Physicians Clinical Practice Guideline

Abstract: Obstructive sleep apnea (OSA) is associated with significant morbidity in pregnancy. There is minimal guidance available on how best to screen, diagnose, treat, and re-evaluate for OSA in pregnant patients. Considering the potentially adverse consequences of OSA in pregnancy if left untreated, we assembled a panel of experts to methodologically review the available literature and make evidence-based recommendations. Rigorous methodology was applied to provide a trustworthy evidence-based guideline and expert panel report. Panelists developed key clinical questions utilizing the PICO (population, intervention, comparator, and outcome) format, addressing specific topics in OSA in pregnant individuals. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature and supplemented by manual searches. References were screened with study evaluation tools to assess for inclusion, extract meaningful data, and grade the level of evidence to support each recommendation or suggestion. PICO questions related to screening, diagnosis, treatment, and follow up of OSA in pregnant patients resulted in nine conditional recommendations, made with the evidence available and with consensus of the expert panel. We recommend screening pregnant patients for OSA, either with a pregnancy specific screening questionnaire or a standard tool. For those at risk of OSA based on screening, either a home sleep test (HST) or in laboratory polysomnogram (PSG) is recommended for diagnosis. We recommend treatment for those with an apnea-hypopnea index (AHI) of 5-15 who have symptoms/sequelae or comorbidities, or those with an AHI ≥ 15 regardless of symptoms or comorbidities, preferably with auto-titrating positive airway pressure (APAP). Additionally, scheduled naps may be beneficial as an initial step in alleviating residual symptoms. Reassessment of OSA in the postpartum period is recommended in some patients. Due to low level of certainty, nine conditional recommendations were made in the screening, testing, and treatment of OSA in pregnancy.

D'Ambrosio CM
Dust C
Dominguez JE
Habib AS
Izci-Balserak B
Louis JM
Louis M
Malhamé I
Olson-Koutrouvelis G
Reutrakul S
Sanapo L
Shaib F
Wilson D
Vintch JRE
Won C
Boujeily G


Management of Adult Bronchiectasis: An American College of Chest Physicians Clinical Practice Guideline

Abstract: Bronchiectasis is a chronic respiratory condition involving a cycle of impaired mucociliary clearance, chronic infections, inflammation, and progressive airway destruction, leading to persistent cough with sputum production, dyspnea, and fatigue. Without appropriate management, patients can experience increased exacerbations, reduced quality of life, declining lung function, and increased mortality risk. Variability exists in clinical practice regarding treatment selection, highlighting the need for evidence-based guidance to optimize patient outcomes and standardize care delivery across healthcare settings. An expert panel developed eight PICO-based questions addressing treatment of bronchiectasis in adults and conducted a systematic review. The panel applied the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to assess the certainty of evidence and to formulate and grade recommendations. A modified Delphi technique was used to reach consensus on the recommendations. Based on 47 studies, the panel developed 13 evidence-based recommendations addressing key management domains, including antibiotic treatment for acute exacerbations, duration and route of antibiotic therapy, long-term suppressive antibiotic and anti-inflammatory therapies, airway clearance strategies, management of hemoptysis and consideration of surgical resection in selected patients. All recommendations are conditional, primarily based on low-certainty evidence. Bronchiectasis research should aim to address many of the uncertainties in management, and priorities are identified within each PICO question. Accurate phenotyping and endotyping may help guide therapeutic decision-making and risk stratification. Treatment interventions must consider potential treatment burdens, including cost, and impact on quality of life. Finally, shared decision-making with patients utilizing a multidisciplinary approach is paramount.

Thomson R
Thornton C
Aksamit T
Barker A
Basavaraj A
Burr L
Hill AT
Jarand J
Lee AL
Metersky M
Moores L
Morimoto K
O'Donnell A
Smith M
Somayaji R
Tino G
Frazer-Green L


Brazilian guidelines for the diagnosis and treatment of candidemia and invasive candidiasis in adults and children

Abstract: Invasive candidiasis, including candidemia and deep-seated Candida infections, remains a major cause of morbidity and mortality in hospitalized patients worldwide, particularly in low- and middle-income countries. In Brazil, candidemia is associated with persistently high mortality rates, driven by late diagnosis, limited access to antifungal agents, and heterogeneous diagnostic capacity. The last national guideline issued by the Brazilian Society of Infectious Diseases (SBI) was published in 2013, and substantial advances have occurred since then in epidemiology, diagnostics, and antifungal therapy. To provide an updated, evidence-based Brazilian guideline for the diagnosis and treatment of candidemia and invasive candidiasis in adults and children, incorporating contemporary scientific data and addressing the specific epidemiological, diagnostic, and therapeutic realities of Brazil. This guideline was developed by the SBI Mycology Committee through a structured consensus process. Clinical questions were formulated using the PICO framework, followed by systematic literature searches of PubMed-indexed studies and international guidelines. Recommendations were contextualized according to Brazilian epidemiology, laboratory infrastructure, and access to antifungal therapies. Key updates include revised epidemiological data from Brazilian cohorts, updated recommendations for blood culture strategies and non-culture-based diagnostics, refined indications for echocardiography and fundoscopy, and updated therapeutic algorithms. Novel antifungal agents, including long acting echinocandins such as rezafungin, are discussed. Emphasis is placed on early echinocandin therapy, timely source control, antifungal stewardship, and infectious diseases consultation. This updated Brazilian guideline reflects current scientific evidence while addressing national healthcare realities, aiming to standardize care, improve outcomes, and reduce mortality associated with invasive candidiasis in Brazil.

The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases

Colombo AL
Magri MMC
Carlesse F
Falci DR
Garnica M
Santos DWCL
Queiroz-Telles F
Pasqualotto AC

Humans
Candidemia
Antifungal Agents
Brazil
Candidiasis, Invasive
Adult
Child

Journal Article
Practice Guideline
Review


Pulmonary Embolism Reporting and Data System (PE-RADS™) v2026 for the Diagnosis of Acute Pulmonary Embolism on CT and MR Angiography

Abstract: Pulmonary embolism (PE), defined as blockage of the pulmonary arteries, is a common and serious condition that requires accurate diagnosis and standardized reporting. Noninvasive imaging is well established for the diagnosis and management of PE and is incorporated into multiple societal guidelines. However, specific technical recommendations for the optimal interpretation and standardized reporting of CT and MR angiography remain absent. Diagnostic imaging is used to identify the presence or absence of PE and to risk-stratify patients. Evolving treatment options can be considered once an acute clot is identified, the patient's status is defined, and the patient is referred for appropriate treatment in a timely manner. Patient management for PE often involves multiple care teams, and clear and consistent communication between care teams is critical to patient care. The goal of the Pulmonary Embolism Reporting and Data System (PE-RADS) is twofold: (a) to create a standard lexicon for the description of terms used for acute PE diagnosis at CT and MR angiography and (b) to develop a structured, hierarchical reporting system that incorporates anatomic and accessory findings to classify clot location and right heart imaging features in acute PE and to assist in determining the cardiovascular status of the patient to inform next-step management.

Koweek LM
Agarwal P
Brosnahan SB
Bhalla S
Bishay V
Cronin P
François CJ
Giri J
Litmanovich DE
Leung AN
West FM
Zimmerman SL


Consensus-Based Development of a Surgical Checklist for Transurethral Resection of Bladder Tumor: An Initiative of the Japanese Society of Urologic Oncology

Abstract: This study aimed to develop a nationwide, consensus-based surgical checklist to standardize transurethral resection of bladder tumor procedures and documentation. In 2025, the Japanese Society of Urologic Oncology convened a working group of 20 bladder cancer specialist urologists to develop a national surgical checklist for transurethral resection of bladder tumors. A 12-member steering committee reviewed available evidence and proposed 30 candidate items. Using a modified Delphi approach, all members rated each item online, with consensus predefined as ≥ 75% agreement. Iterative revisions incorporating public comments and external expert input produced the final checklist. The final checklist comprised 22 items across four sections: (i) preoperative patient and tumor information (recurrence status; upper tract urothelial carcinoma; urine cytology; clinical Tumor-Node-Metastasis staging; performance status; factors affecting surgery/anesthesia); (ii) surgical and anesthetic planning (surgical intent; resection technique; adjunctive imaging modality; additional biopsies; anesthesia method; obturator reflex prophylaxis); (iii) intraoperative tumor and resection information (tumor number; index tumor morphology; index tumor size; findings suggestive of carcinoma in situ; extent of tumor resection; detrusor muscle visible; muscle invasion suspected); and (iv) complications and adjuvant therapy (urethral stricture; intraoperative complications; immediate single instillation). An additional section provides two bladder diagrams: a male/general-use version with lower urinary tract annotations and a female-specific version, both designed for mapping tumor location, characteristics, and operative findings. This checklist provides a practical framework to standardize transurethral resection of bladder tumor practice and documentation and support safe, high-quality care, warranting prospective evaluation of feasibility, adherence, and quality indicators/outcomes.

International journal of urology : official journal of the Japanese Urological Association

Taoka R
Hayakawa N
Kimura T
Kikuchi E
Iwatani K
Kato M
Matsumoto T
Tanaka H
Sano T
Hara T
Fukuhara H
Miyake M
Osawa T
Hatakeyama S
Kobayashi T
Inokuchi J
Tatarano S
Kitamura H
Sugimoto M
Nonomura N

Humans
Checklist
Consensus
Delphi Technique
Japan
Medical Oncology
Neoplasm Recurrence, Local
Neoplasm Staging
Societies, Medical
Transurethral Resection of Bladder
Urinary Bladder
Urinary Bladder Neoplasms
Urology


The 2026 British Society for Rheumatology guideline for pain management in people with inflammatory arthritis

Abstract: Pain is a frequent symptom in people with inflammatory arthritis (IA), which has substantial impact on their quality of life. Analyses of electronic health record data indicate that UK pain care in people with IA often involves prescribing long-term opioids and gabapentinoids, despite absent trial evidence for efficacy. Patient survey data suggest that non-pharmacological pain care with supportive trial evidence is underused. A UK-specific guideline on pain management for people with IA is required to address this. This comprehensive life-course guideline is the first British Society for Rheumatology Guideline to specifically address pain in people with IA. It provides evidence-based recommendations on how pain can be best managed in people with IA. It was developed using the methods outlined in the British Society for Rheumatology's 'Creating Clinical Guidelines' protocol by a multidisciplinary Guideline Working Group, comprising healthcare professionals with expertise in paediatric and adult rheumatology and people with lived experience. By undertaking and considering the evidence from several systematic literature and umbrella reviews, 23 recommendations were developed. These address how pain should be assessed in people with IA alongside the role of the following treatments in IA pain management: DMARDs, glucocorticoids, analgesics, neuromodulators, exercise and physical activity, psychological interventions, ergonomic and orthotic interventions (excluding orthoses for foot pain), education, weight management and diet, addressing sleep problems, fatigue management, digital technologies and medical devices, complementary therapies, and support from others. An audit tool is provided to support the Guideline's implementation, and key recommendations made for future research.

Scott IC
Smith TM
Babatunde O
Barker C
Battista S
Beesley R
Beesley R
Birkinshaw H
Brooke M
Chaplin H
Chapman L
Ciurtin C
Dale J
Dockrell D
Dures E
Harrison K
Holt S
Jani M
McCarron M
Mallen CD
O'Connor A
Pidgeon C
Pratt D
Prior Y
Raza K
Rutter-Locher Z
Sharma S
Shaw K
Tsigarides J
Xenophontos M
Shenker NG

Humans
Pain Management
United Kingdom
Rheumatology
Arthritis
Arthritis, Rheumatoid
Societies, Medical
Analgesics
Antirheumatic Agents
Quality of Life


The Society of Thoracic Surgeons Expert Consensus Document on Tricuspid Valve Endocarditis in People Who Inject Drugs

Abstract: Tricuspid valve endocarditis in people who inject drugs represents a unique clinical and social challenge for cardiac surgeons. There is a relative paucity of research specific to this unique clinical scenario to guide evidence-based treatment. The Society of Thoracic Surgeons Workforce on Evidence Based Surgery assembled a writing group in 2024 to create an expert consensus document on the management of tricuspid endocarditis in people who inject drugs. A comprehensive literature search was conducted in Medline, focusing on studies published in English over the past 15 years. The consensus was reached using a modified Delphi method, with each member voting on statements via a 5-point Likert scale to assess wording and strength. Expert consensus statements were generated addressing key topics including vegetation size, impact of infectious organism on surgical decision making, persistent bacteremia, prosthetic valve infections, surgical strategy, emerging technologies, and ethical considerations. Included expert consensus statements offers insight based on the literature a clinical experience about important topics when managing tricuspid valve endocarditis in patients who inject drugs.

Goldberg JB
Mehaffey JH
Paras ML
Vardas PN
Pattakos G
Slaughter MS
Arnaoutakis GJ
Whitson BA
Wyler von Ballmoos MC


[2025 Multidisciplinary International Working Group Consensus Practice Guidelines: Sacroiliac joint complex pain interpretation]

Abstract: Over the past two decades, significant advancements have been achieved in the diagnosis and treatment of sacroiliac joint (SIJ) complex pain. These advances include anatomical studies elucidating the neural innervation mechanisms, research clarifying the impacts of extra-articular factors on SIJ complex pain, and the clinical application of radiofrequency ablation as well as a wide spectrum of minimally invasive surgical techniques. Nevertheless, a unified standardized protocol for the diagnosis and treatment of SIJ complex pain remains to be established. In 2025, the American Academy of Pain Medicine (AAPM) and the American Society of Regional Anesthesia and Pain Medicine (ASRA-PM) convened 27 professional organizations to revise and promulgate multidisciplinary clinical practice guideline for SIJ complex pain. This article conducts a comprehensive interpretation of the aforementioned guideline, compares it with relevant expert consensus documents in China, analyzes the consistencies and divergences in their diagnosis and treatment, and provides a reference for clinical practice.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi

Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery

Chen S
Yang Z
Zhang J
Lü B
Zhang Y
Han N

Humans
Sacroiliac Joint
Low Back Pain
Pain Management
Injections, Intra-Articular
Pain Measurement
Adrenal Cortex Hormones


Supporting Research and Graduate Education in a Troubled Landscape: Report of the 2025-2026 AACP Research and Graduate Affairs Committee

Abstract: U.S. colleges and schools of pharmacy face mounting challenges in sustaining robust research programs, supporting early-stage investigators, modernizing graduate education, and integrating emerging technologies into academic practice. Furthermore, shifts in federal funding-particularly within the National Institutes of Health (NIH), National Science Foundation (NSF) and the Agency for Healthcare Research and Quality (AHRQ), increased expectations for multidisciplinary collaboration, and rapid technological transformation require coordinated national leadership. This report is intended to identify key research and graduate education challenges across the Academy and propose actionable strategies for the American Association of Colleges of Pharmacy (AACP or the Association). Recommendations focus on strengthening and diversifying research funding, enhancing infrastructure for multidisciplinary collaboration, supporting early-stage investigators, aligning graduate training with workforce needs, improving domestic recruitment pipelines, and establishing competency frameworks for artificial intelligence (AI) integration. This report also addresses professional identity formation of scientists within pharmacy education and research and what being a scientist means in different settings, including the classroom, the clinic, and the community. Recommendations are given to support scientists in building identity around the competencies and skills that enable scientific problem solving, communication, education, and advocacy in all settings - all consistent with domains that are already included in the AACP Competency Framework for Graduate Education. The report concludes with a call to action for both AACP and member institutions to modernize policies, invest strategically in research ecosystems, and ensure the long-term vitality of pharmacy research and graduate education.

American journal of pharmaceutical education

Coop A
Early J
Iso T
Lu K
Qian J
Perez A
Subramaniam S
Zaccheo N
Farrell D
Xie W


Transcranial Direct Current Stimulation (tDCS) Application in Neurorehabilitation: A Beginner's Guide for Clinicians

Iddings JA
Petrosyan H
Jo HJ
Benavides F
Sisto SA


EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2026 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent

Abstract: To present a summary of the 2026 version of the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Urological Pathology (ISUP)-International Society of Geriatric Oncology (SIOG) guidelines on screening, diagnosis, and treatment of clinically localised prostate cancer (PCa). The Panel performed a literature review of all new data published in English, covering the time frame between May 2023 and 2025. The Guidelines were updated, and a strength rating for each recommendation was added based on a systematic review of the evidence. A risk-adapted strategy for identifying men who may develop PCa is advised, generally commencing at 50 yr of age and based on individualised life expectancy. The use of multiparametric magnetic resonance imaging to avoid unnecessary biopsies is recommended. When a biopsy is considered, a combination of targeted and regional biopsies should be performed. A new five-tier EAU classification has been introduced. Prostate-specific membrane antigen positron emission tomography imaging is the most sensitive technique for identifying metastatic spread. Active surveillance is the appropriate management for men with low-risk PCa, as well as for patients with selected favourable intermediate-risk ISUP grade group 2 lesions. Local therapies are addressed, as well as the management of persistent prostate-specific antigen after surgery. A recommendation to consider hypofractionated radiotherapy in intermediate-risk patients is provided. Patients with cN1 PCa should be offered radiotherapy to the primary tumour combined with long-term intensified hormonal treatment. The evidence in the field of diagnosis, staging, and treatment of localised PCa is evolving rapidly. These PCa Guidelines reflect the multidisciplinary nature of PCa management.

Cornford P
van den Bergh RCN
Briers E
Chiu P
Eberli D
Epure A
Farolfi A
Fonteyne V
Gandaglia G
Gillessen S
Grivas N
Henry AM
van Leenders GJLH
Espinos EL
Matsen B
Oldenburg J
van Oort IM
Oprea-Lager DE
Roberts MJ
Rouvière O
Sachdeva A
Santis M
Schoots IG
Smith EJ
Stranne J
Wiegel T
Tilki D


European Association of Urology Guidelines on Urological Infections: Summary of the 2026 Guidelines

Abstract: Urological infections significantly impact individuals' well-being and quality of life due to their widespread occurrence and diverse clinical manifestations. This work aims to provide evidence-based guidance on diagnosing, treating, and preventing urinary tract infections (UTIs) and male accessory gland infections, while addressing crucial public health aspects related to infection control and antimicrobial stewardship. For the 2026 Urological Infections Guidelines, new and relevant evidence was identified, collated, and appraised through a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Library. Recommendations within the Guidelines were developed by the panels to prioritise clinically important care decisions. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and the nature and variability of patient values and preferences. Key recommendations emphasise the importance of thorough medical history and physical examination for patients with urological infections. The guidelines stress the role of antimicrobial stewardship to combat the rising threat of antimicrobial resistance, providing recommendations for antibiotic selection, dosing, and duration based on the latest evidence. Key updates in the 2026 Urological Infections Guidelines summary include: comprehensive restructuring of the guideline framework in alignment with the new classification system for UTIs; the addition of a new chapter on the diagnosis and management of Herpes simplex virus; the addition of a new chapter on the diagnosis and treatment of fungal UTIs; and an update of the evidence and recommendations on periprocedural antibiotic prophylaxis for prostate biopsy. This overview of the 2026 European Association of Urology (EAU) guidelines offers valuable insights into the classification, diagnosis, and treatment of urological infections and is designed to be effectively integrated into clinical practice.

Kranz J
Cai T
Geerlings S
Köves B
Lambregts MMC
Mantica G
Pilatz A
Medina-Polo J
Schneidewind L
Schubert S
Vallée M
Veeratterapillay R
Wagenlehner F
Bausch K
Devlies W
Leitner L
Stangl F
Ali H
Smith EJ
Bonkat G


SCAI/ASE/HRS/SIR/SVS Expert Consensus Statement on Enhanced Radiation Protection: Time for Mandatory and Urgent Action

Abstract: Health care professionals in fluoroscopic laboratories face significant occupational hazards, including cancer, cataracts, and reproductive concerns due to prolonged exposure to iodizing radiation, and orthopedic injuries stemming from long-term use of heavy aprons as protection from radiation. Despite substantial advancements in radiation protection technology, adoption of these advancements has been slow, hindered by the high upfront costs of implementation and the lag in revising institutional and regulatory radiation exposure thresholds to reflect the capabilities of contemporary enhanced radiation protection devices (ERPDs). This multisociety statement, endorsed by the Society for Cardiovascular Angiography & Interventions, American College of Cardiology, the American Society of Echocardiography, the Heart Rhythm Society, the Society of Interventional Radiology, and the Society for Vascular Surgery, calls for mandatory implementation of ERPDs to meet as low as reasonably achievable standards. This expert consensus statement outlines the ethical and legal responsibilities of government, fluoroscopy laboratory manufacturers, and health care institutions to protect all health care professionals from avoidable workplace hazards and the urgent need to implement ERPDs. The document does not promote or recommend any single ERPD system, and the choice of protection technology is left to department preference. It also addresses the importance of training, monitoring, and continuous research to optimize radiation safety practices. The document advocates for updated regulations and standardized practices across states to ensure comprehensive protection for all fluoroscopy laboratory personnel.

Rizik DG
Sutton NR
Lansky AJ
Alasnag M
Bartal G
Brady MB
Coylewright M
Goldstein JA
Firestone SM
Goldsweig AM
Kereiakes DJ
Kirkwood M
Madder RD
Mehran R
Nicholson WJ
Paulo G
Rao SV
Rosenfield K
Schultz CC
Tamirisa KP
Tuozzo KA
Velagapudi P
Vora AN
Yong CM
Hermiller JB


REFCOR guidelines on the management of olfactory neuroblastoma: A formalized expert consensus

Abstract: Olfactory neuroblastoma (ONB) is a rare malignant tumor of the sinonasal tract. The objective of this study is to present an evidence-based synthesis of the recommendations of the French Expert Network of Rare ENT Cancers (REFCOR), published in 2022, concerning the diagnostic and therapeutic management of ONB. These recommendations result from a multidisciplinary consensus based on a critical analysis of the literature and feedback from expert centers within a structured process. ONB accounts for 6% of sinonasal cancers, with no identified risk factors. Diagnosis is based on CT and MRI of the paranasal sinuses and skull base, together with systemic disease staging. Histopathological analysis requires specialized expertise, with Hyams histological grade as the main prognostic factor. The standard of care consists in surgical resection followed by adjuvant radiotherapy. Chemotherapy may be considered in high-grade or unresectable forms. Because of the risk of late recurrence, at least 20years' follow-up is recommended. The REFCOR guidelines aim to standardize diagnosis and treatment for ONB, but require completion by discussion in a specialized multidisciplinary tumor board.

European annals of otorhinolaryngology, head and neck diseases

Gorzkowski V
Monnot C
Castain C
de Bonnecaze G
Verillaud B
Michel J
Moya-Plana A
Coste-Martineau V
Digue L
Thariat J
Dupin C
de Gabory L
Rumeau C

Humans
Esthesioneuroblastoma, Olfactory
Nose Neoplasms
Nasal Cavity
Neoplasm Staging
Consensus
France

Journal Article
Practice Guideline
Consensus Statement


Dépistage de la consommation d’alcool à risque élevé et du trouble d’utilisation de l’alcool : mise à jour du guide de pratique clinique national de 2023

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

Wood E
Wong SC
Corace K
Martell D
Barker B
de Montigny C
Hodgins DC
Poulin G
Halpape K
Le Foll B
Lim R
Brosseau A
Henry R
Marsh DC
Cowan N
Teed R
Johnson C
Brunelle C
Graham B
Rehm J

Humans
Canada
Mass Screening
Alcoholism
Alcohol Drinking
Practice Guidelines as Topic
Alcohol-Related Disorders
Risk Assessment

Journal Article
Practice Guideline
Systematic Review


Reproductive health guidance for the cystic fibrosis community: a Cystic Fibrosis Foundation Position Paper

Abstract: The Cystic Fibrosis Foundation organised a multidisciplinary committee to develop this Position Paper to outline current knowledge and best practices in reproductive health care for individuals with cystic fibrosis. Working groups reviewed the literature and provided relevant guidance on reproductive health services, fertility, contraception, preconception and pregnancy, and cystic fibrosis transmembrane conductance regulator (CFTR) modulator exposure in utero and during lactation. Findings included: (1) reproductive health-care provision should be standardised, and education should begin at cystic fibrosis diagnosis and revisited annually; (2) contraception is safe overall, but underutilised in those with cystic fibrosis compared with the general population; (3) fertility might be improving with CFTR modulators for females with cystic fibrosis, but not for males with cystic fibrosis-assisted reproductive technologies are still required for males to achieve biological parenthood; (4) pregnancy requires close monitoring and unique screening for diabetes; and (5) CFTR modulator exposure in utero has implications for infant monitoring and cystic fibrosis screening results in newborns.

Jain R
Taylor JL
Kazmerski TM
Lonabaugh K
Trimble A
Velez Leitner D
Foil K
Hong G
Johns WB
Kolarova T
Meier E
Perry A
Singh KE
Stahl C
Szentpetery S
Weiss MS
West NE
Wilson A
Wright B
Brown AW
Hempstead SE
Lomas P
Middleton PG
Shteinberg M
Felton I
Roe AH

Cystic Fibrosis Transmembrane Conductance Regulator

Journal Article
Review
Consensus Statement
Practice Guideline


Canadian Network for Mood and Anxiety Treatments (CANMAT) and International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) 2025 international guidelines for the management of patients with obsessive-compulsive disorder

Abstract: As a joint effort by the Canadian Network for Mood and Anxiety Treatments (CANMAT) and the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS), these treatment guidelines provide an up-to-date synthesis of published literature on the efficacy, safety, and tolerability of the range of interventions available for the management of obsessive-compulsive disorder (OCD) across the lifespan. The primary goal is to provide clear, easy to use recommendations for practicing clinicians. A global group of OCD experts were divided into panels to develop specific sections based on internal group discussions and the evidence extracted from systematic literature searches. CANMAT-defined Levels of Evidence, as well as level of clinical support were used to inform Lines of Treatment and final treatment recommendations. Drafts were revised based on feedback from individuals with lived experience, expert peer review, and a defined expert consensus process. These OCD Guidelines include seven sections spanning foundations of management and diagnosis, psychological, pharmacological, and neuro-modulation treatment modalities, treatment resistance, children and adolescents, special populations and future directions. Recommendations are summarized in tables for ease of reference and caveats and limitations of the current evidence are discussed. The CANMAT/ICOCS 2025 OCD International Guidelines synthesize the evidence on the efficacy, safety, and tolerability of the range of interventions available for the management of OCD. It is anticipated that these new OCD guidelines will enable psychiatrists and other clinicians to provide systematic, evidence-based care for their patients with OCD across the lifespan.

Van Ameringen M
Fineberg NA
Ravindran A
Arnold PD
Beaulieu S
Brakoulias V
Brietzke E
Dowlati Y
Drummond LM
Ferretti CJ
Feusner JD
Freire RCR
Frey BN
Gardiner S
Geller DA
Giacobbe P
Bergmann CG
Grassi G
Greenberg E
Hollander E
Hopkinson P
Kennedy SH
Lam RW
Lochner C
McGuire JF
McQuay S
Menchon JM
Milev R
Minuzzi L
Mojgani J
Mpavaenda DN
Nicolini H
Pallanti S
Pampaloni I
Parikh SV
Patterson B
Ravindran L
Reid J
Rodriguez CI
Samaan Z
Schaffer A
Smigielski L
Taylor VH
Tourjman SV
van Roessel P
Vigod SN
Walitza S
Yatham LN
Zohar J
Zugliani M
Dell'Osso BM

Humans
Canada
Obsessive-Compulsive Disorder
Practice Guidelines as Topic


Evidence-Based Guidelines for the Diagnosis and Treatment of Helicobacter pylori Infection in Korea: 2025 Revised Edition

Abstract: Since the 2020 Korean guidelines for Helicobacter pylori treatment, clarithromycin resistance rates have risen from 17.8% to 33.3%, dual-priming oligonucleotide-based polymerase chain reaction (DPO-PCR)-based tailored therapy has been adopted, and P-CABs have become available. This fourth revision addresses these changes. Nine key questions were addressed through systematic reviews with meta-analyses. Thirteen recommendations were evaluated via modified Delphi process involving 64 experts. Twelve recommendations achieved first-round consensus; one required revision and achieved 73.9% agreement. Key changes: (1) dual-pillar strategy of tailored therapy and empirical quadruple therapy; (2) restricted use of empirical clarithromycin-based triple therapy under specific conditions; (3) removal of sequential therapy; (4) P-CABs as PPI alternatives; (5) expansion of eradication indications to include gastric cancer prevention in H. pylori gastritis and regression of hyperplastic polyps ≤ 10 mm; and (6) positioning of bismuth quadruple therapy as a conditionally recommended first-line empirical option with preference for reservation as salvage therapy, and introduction of modified bismuth quadruple therapy (addition of bismuth to conventional regimens) as an additional first-line empirical option. This fourth revised guideline provides updated, evidence-based recommendations for the diagnosis and treatment of H. pylori infection, reflecting the rapidly changing antibiotic resistance landscape and the introduction of new diagnostic and therapeutic tools in Korea. These guidelines aim to assist clinicians, patients, policymakers, and medical educators in optimizing H. pylori management. They may differ from current medical insurance standards and will be revised further based on emerging evidence.

Korean College of Helicobacter and Upper Gastrointestinal Research

Helicobacter Infections
Humans
Helicobacter pylori
Republic of Korea
Anti-Bacterial Agents
Drug Therapy, Combination
Drug Resistance, Bacterial
Clarithromycin


Program Guidelines for the National Lung Cancer Screening Program: Targeted Lung Cancer Screening in High-Risk Individuals in Australia

Abstract: Lung cancer is the leading cause of cancer mortality in Australia. In July 2025, the Australian Government launched the National Lung Cancer Screening Program (the Program). The Program has been designed in accordance with the Medical Services Advisory Committee's recommendations. This article summarises the program guidelines, outlining Program parameters and delivery requirements. The screening and assessment pathway defines the Program structure. The purpose of the guidelines is to ensure safe, effective and high-quality Program delivery, detailing key steps for clinical practice and information for participating healthcare providers. The guidelines provide recommendations for the delivery of targeted low-dose CT screening for lung cancer in the Australian context. Program eligibility is assessed using risk-based eligibility criteria recommended by the Medical Services Advisory Committee, targeting people between 50 and 70 years of age with a history of tobacco cigarette smoking. Smoking cessation supports are to be offered to all potential participants by healthcare providers across the lung cancer screening and assessment pathway. Low-dose CT scan assessment and reporting follow the National Lung Cancer Screening Program's nodule management protocol. This guideline provides recommendations for the delivery of targeted low-dose CT screening for lung cancer in the Australian context. Content includes: guidance on assessing Program eligibility; enrolling eligible participants in the National Cancer Screening Register; completing and fulfilling low-dose CT scan requests; assessing and reporting low-dose CT scan results; managing scan outcomes and actionable additional findings; and communicating scan results. The full guideline is available at https://www.health.gov.au/resources/publications/nlcsp-guidelines.

Rankin NM
Zosel R
Whop LJ
Maddox R
McWilliams A
Siemienowicz M
Emery J
Lantin MAR
Bartlett G
Wolfe M
Diaz A
Anderson K
Liu L
Toms C
McDermott S
Bligh P
Chalke J
Melsom S
Nightingale CE
Brown A
Pope S
Brotherton J
Fidler A
Itel M
Brooke M
Pascoe DM
Brims F
Leong TL
Stone E
Keefe D
Milch V

Humans
Lung Neoplasms
Australia
Early Detection of Cancer
Tomography, X-Ray Computed
Mass Screening
Middle Aged
Aged
Smoking Cessation
Practice Guidelines as Topic


[Interpretation of the 2025 Wilderness Medical Society Clinical Practice Guideline on Care of Burns in the Wilderness]

Abstract: The Wilderness Medical Society released the first edition of the Wilderness Medical Society Clinical Practice Guideline on Care of Burns in the Wilderness in June 2025. This guideline offers evidence-based recommendations for the management of burn injuries in wilderness environments, including on-site burn assessment, field first aid, evaluation of burn depth and total body surface area, blister care, fluid resuscitation, wound dressing, pain control, post-injury evacuation, and telemedicine applications. This article interprets the guideline, aiming to inform clinical practitioners of recent advances in wilderness burn care and provide evidence-based references for clinical practice.

Burns
Humans
Wilderness Medicine
Societies, Medical


No. 469 Iron Deficiency and Iron Deficiency Anemia in Obstetrics and Gynaecology

Abstract: The purpose of this guideline is to provide an evidence-based framework for healthcare professionals to recognize, manage, and prevent iron deficiency and iron deficiency anemia across the lifecycle of women, with particular emphasis on time periods of vulnerability, such as pregnancy, menstruation, and perioperatively. This clinical practice guideline seeks to improve the lives of women at all reproductive life stages, from menarche to menopause, with iron deficiency and iron deficiency anemia in the context of obstetrical and gynaecologic care. This guideline reviews the available options for the prevention, assessment, and treatment of iron deficiency and iron deficiency anemia. While the focus of this guideline pertains to oral and intravenous iron replacement therapy, the importance of reducing menstrual blood loss is also emphasized. By consolidating the best evidence to date with expert opinion across the disciplines of obstetrics and gynaecology, hematology, and anaesthesiology, we provide recommendations and treatment algorithms to guide the diagnosis and treatment of iron deficiency and iron deficiency anemia for patients within our specialty. The prevention, early identification, and treatment of iron deficiency and iron deficiency anemia is assessed to be a cost-effective strategy to improve the health and well-being of women of reproductive age. This proactive approach to iron deficiency and iron deficiency anemia has also been shown to reduce the need for blood transfusion, along with the associated harms and costs of transfusion. The potential costs of iron infusion therapy must be assessed in the context of the profound adverse impacts on quality of life, reduced work performance and decreased economic productivity of patients with iron deficiency and iron deficiency anemia. Using relevant MeSH headings and keywords (related to concepts of anemia, iron deficiency, blood management, blood conservation, transfusion, obstetrics, pregnancy, postpartum, and gynaecology), published literature was retrieved through searches of PubMed and Cochrane Systematic Reviews from January 2015 to December 2025. Grey literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, and national and international medical specialty societies. This guideline was developed through consensus by a multidisciplinary team of authors with representation from obstetrics, gynaecology, anaesthesiology, and hematology. The content and recommendations were drafted and agreed upon by the authors. The SOGC's Clinical Obstetrics and Gynaecology Committee reviewed the guideline and the Guideline Management and Oversight Committee approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework. See online Appendix A (Tables A1 for definitions and A2 for interpretations). A national panel of patient partners was gathered to provide feedback and perspective on the recommendations and summary statements for this guideline. Community partners were purposefully selected to ensure representation of Canadian geographic regions, lived experience with iron deficiency or iron deficiency anemia, as well as obstetrical or gynaecologic care received. Healthcare providers involved in the assessment and management of women with iron deficiency and iron deficiency anemia. Iron deficiency (ID) and iron deficiency anemia (IDA) have profound impacts on the quality of life in women worldwide. As such, the early identification of ID/IDA and iron replacement therapy is an important strategy for women's health and wellbeing. General Principles of Diagnosis and Treatment GYNAECOLOGY: PRECONCEPTION, PREGNANCY, AND POSTPARTUM: RECOMMENDATIONS: General Principles of Diagnosis and Treatment GYNAECOLOGY: PRECONCEPTION, PREGNANCY, AND POSTPARTUM.

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC

Chen I
Khamisa K
Murji A
Coolen J
Evans D
Lett R
Rittenberg D
Lett C


N° 469 Carence en fer et anémie ferriprive en obstétrique et en gynécologie


Breast Cancer, Version 4.2026, NCCN Clinical Practice Guidelines In Oncology

Abstract: The NCCN Clinical Practice Guidelines for Breast Cancer include recommendations for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget's disease, Phyllodes tumor, inflammatory breast cancer, and management of breast cancer during pregnancy. The panel convenes annually to update recommendations based on a review of recently published clinical trials. This selection from the NCCN Guidelines for Breast Cancer focuses on the recommendations for the management of recurrent or stage IV (M1) metastatic breast cancer. It summarizes the treatment strategies stratified by tumor biology, including hormone receptor status and HER2 expression, as well as clinical factors such as prior therapy and disease-free interval. Throughout all treatment lines, supportive care, quality of life preservation, toxicity minimization, and clinical trial participation are emphasized as integral components of patient care.

Journal of the National Comprehensive Cancer Network : JNCCN

Gradishar WJ
Moran MS
Abraham J
Abramson V
Aft R
Agnese D
Allison KH
Anderson B
Bailey J
Burstein HJ
Chen N
Chew H
Dang C
Elias AD
Giordano SH
Goetz MP
Jankowitz RC
Javid SH
Leitch AM
Lyons J
McCloskey S
McShane M
Patel SA
Rosenberger LH
Rugo HS
Santa-Maria CA
Schneider BP
Smith ML
Soliman H
Speers C
Telli ML
Wei M
Wisinski KB
Yellala A
Yeung KT
Young JS
Schonfeld R
Kumar R

Humans
Breast Neoplasms
Female
Medical Oncology
Neoplasm Staging


NCCN Guidelines® Insights: Myeloproliferative Neoplasms, Version 2.2026

Abstract: The Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) are a group of heterogenous hematologic malignancies characterized by the proliferation of blood cells and consist of myelofibrosis, polycythemia vera, and essential thrombocythemia. The NCCN Guidelines for MPN were developed as a result of meetings convened by a multidisciplinary panel with expertise in MPN, with the aim of providing recommendations for the comprehensive care of adults with these diseases. The panel of experts convenes at least once a year to discuss requested changes to the Guidelines and to evaluate emerging data. These Guideline Insights focus on some of the recent updates for myelofibrosis.

Gerds AT
Gotlib J
Abdelmessieh P
Ali H
Castells M
Chernak BJ
Espinoza-Gutarra MR
Fein Revell R
Green S
Gundabolu K
Hexner E
Jain T
Jamieson CH
Khan I
Kuykendall AT
Madanat YF
Masarova L
McMahon B
Mohan SR
Nadiminti KV
Oh S
Palmer J
Patel AB
Patel AA
Podoltsev N
Rein L
Salit R
Sehl M
Talpaz M
Wadleigh M
Wall SA
Bergman MA
Hochstetler C

Humans
Myeloproliferative Disorders
Primary Myelofibrosis


Diagnosis and treatment of venous thromboembolic disease in children. Recommendations from the Thromboembolic Disease Working Group of the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Thrombosis and Hemostasis (SETH) and the Spanish Society of Pediatric Hematology and Oncology (SEHOP)

Abstract: Venous thromboembolism (VTE) in children is a rare condition. It encompasses different clinical scenarios that require an individualized and multidisciplinary approach. The aim of this document is to provide a practical guideline for the management of pediatric VTE based on the best available evidence. An exhaustive literature review was performed, gathering information from current clinical guidelines and recent studies. This document compiles the recommendations on the diagnosis and treatment of VTE in infants, children, and adolescents endorsed by the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Thrombosis and Hemostasis (SETH), and the Spanish Society of Pediatric Hematology and Oncology (SEHOP). Neonatal VTE, arterial thrombosis, and superficial venous thrombosis are beyond the scope of this work. This document includes a list of definitions aimed at standardizing terminology and another two distinct sections: (1) particularities of treatment, including recommendations regarding dosing, monitoring and cautions in the pediatric population, and (2) particularities in management, including specific recommendations for the most frequent scenarios in children.

Berrueco R
Falcón M
Argilés B
Campo Palacio HJ
Climent FJ
Gómez Del Castillo MDC
Guirado L
Izquierdo S
López-Almaraz R
Otálora Valderrama S
Puche Palao G
Ruiz-Artacho P

Humans
Child
Venous Thromboembolism
Adolescent
Anticoagulants
Infant
Spain


Guideline on Pelvic Floor Disorders: consensus on Obstructed Defecation Syndrome (ODS)

Abstract: Obstructed defecation syndrome (ODS) is a multifactorial condition that significantly impairs quality of life and presents diagnostic and therapeutic challenges due to the interaction of functional and anatomical factors. This initiative aimed to develop a Belgian consensus and a diagnostic-therapeutic algorithm to support effective clinical management of ODS. A Belgian steering group of gastroenterologists and colorectal surgeons (n=6) conducted a Delphi consensus process. Based on a structured literature review, 82 statements were drafted and discussed during three online voting rounds. Consensus was defined as ≥80% agreement, and evidence strength was graded using the GRADE system. Thirty-one experts participated, including gastroenterologists, colorectal surgeons, gynecologists, and physiotherapists. Sixty-two final statements were formulated, of which 46 were endorsed. ODS was defined as a disorder of anorectal evacuation, with functional and structural components often coexisting. Symptoms overlap with functional constipation, IBS-C, and fecal incontinence, and quality of life is substantially impaired. Diagnosis requires multimodal evaluation, including digital rectal examination and anorectal testing. First-line treatment consists of conservative measures such as lifestyle optimization, laxatives, and pelvic floor re-education. Surgery is reserved for selected patients with refractory symptoms and significant anatomical abnormalities. Tailored surgical approaches are supported for rectocele, rectal prolapse, and pelvic organ prolapse, whereas sacral nerve stimulation is not routinely recommended. These consensus statements provide practical guidance for the diagnosis and management of ODS. Conservative therapy remains the cornerstone, with surgery reserved for selected cases. Areas lacking consensus warrant further research.

Van de Bruaene C
De Schepper H
Surmont M
Van de Putte D
Van den Broeck S
Bislenghi G
Boon K
Casteels P
Cornille J-
De Looze D
Denis MA
François A
Gijsen I
Geldof J
Van Geluwe B
Geraerts I
Hanssens M
Kindt S
Komen N
Meerhout D
Nullens S
Poortmans N
Pletinckx P
Raymenants K
Ruymbeke H
Segaert A
Stockman S
Stijns J
Van Aggelpoel T
Vandenplas L
Roelandt P

Humans
Constipation
Pelvic Floor Disorders
Belgium
Quality of Life
Delphi Technique
Syndrome
Female
Consensus
Digital Rectal Examination


Conventional vs Video-Assisted Laryngoscopy for Perioperative Endotracheal Intubations: A Randomized Clinical Trial

Abstract: Video laryngoscopy is increasingly used in routine tracheal intubation in the operating room, but evidence regarding its clinical outcomes remains inconclusive. In particular, the role of hyperangulated video laryngoscopes as first-choice devices has not been studied sufficiently. To determine whether video laryngoscopy-regardless of blade geometry or manufacturer-provides superior first-pass success compared with direct laryngoscopy (DL) during routine tracheal intubations. This 3-arm randomized clinical trial (Conventional vs Video-Assisted Laryngoscopy for Perioperative Endotracheal Intubation [COVALENT]) was conducted at 6 academic or intermediate care centers in Germany and Austria between March 28, 2022, and February 17, 2025. Adults undergoing surgery under general anesthesia with the need for tracheal intubation were included in the trial. Adults undergoing surgery under any other form of anesthesia, those requiring nasal or planned fiberoptic intubation, and pregnant patients were excluded. Patients were sampled consecutively until trial staff capacity limits were met for any given day. Devices from different manufacturers were allowed to maximize generalizability. All data analyses followed a modified intention-to-treat approach. Tracheal intubation as part of general anesthesia induction preceding surgery. Patients were randomly assigned (1:1:1) to DL, video laryngoscopy with Macintosh blade (VLM), or video laryngoscopy with a hyperangulated blade (VLH). All interventions were performed by the anesthesiologists assigned to their respective cases. The primary outcome was first-pass intubation success rate. After the laryngoscope and tracheal tube were inserted into the patient's oral cavity, retrieval of either marked a failed intubation attempt. Successful intubation was defined as positive capnography. Differences between success rates were tested applying the z test for unpooled variance and reported as absolute differences with corresponding 95% CIs. Of the 2532 patients (1426 males [56.3%]; mean [SD] age, 59.7 [15.4] years) randomly assigned to DL (n = 848), VLM (n = 841), or VLH (n = 843), 2423 (95.7%) were included in a modified intention-to-treat analysis. Both video laryngoscopy modalities were superior to DL regarding first-pass success (VLM: 82.9%, VLH: 87.6%, and DL: 78.2%; all P < .001). Unadjusted absolute risk differences for first-pass intubation success were 4.66 (95% CI, 4.45-4.78) percentage points for DL vs VLM, 9.34 (95% CI, 9.22-9.46) percentage points for DL vs VLH, and 4.68 (95% CI, 4.57-4.79) percentage points for VLM vs VLH. VLM and VLH compared with DL had faster intubation success after a failed first attempt (mean [SD] time to positive capnography, 146.6 [103.6] and 147.5 [98.9] seconds vs 170.3 [100.4] seconds; P = .008). There were fewer complications of lip or dental injuries or blood on the blade for VLH compared with VLM and DL (10.9% [11 of 101] vs 23.2% [32 of 138] and 24.1% [42 of 174]). This randomized clinical trial of DL vs VLM and VLH found that video laryngoscopy significantly improved first-pass success during intubation in the operating room compared with DL. The findings support the use of video laryngoscopy as a new standard of care for routine airway management. ClinicalTrials.gov Identifier: NCT05228288.

German Society of Anaesthesiology and Intensive Care (GSAIC) Trials Group

Video-Assisted Techniques and Procedures

Journal Article
Randomized Controlled Trial
Comparative Study
Multicenter Study


Friendship Quality in Children With ADHD Seeking Treatment for Peer Problems: A Comparison of Boy-Boy, Girl-Girl, and Mixed-Gender Dyads

Abstract: Children with attention-deficit/hyperactivity disorder (ADHD) often experience friendship difficulties, yet little is known about whether friendship quality differs according to the gender composition of their friendships. Drawing on developmental models of gendered friendship processes, we examined whether friendship quality differed across boy-boy, girl-girl, and mixed-gender dyads among children with ADHD. This secondary analysis used baseline data from a randomized clinical trial of children with ADHD aged 6 to 11 who were seeking treatment for peer problems. The sample included 149 children who brought a reciprocated friend to the baseline assessment: 87 boy-boy dyads, 44 girl-girl dyads, and 18 mixed-gender dyads. Friendship quality was assessed using multi-informant questionnaires and direct observations of dyadic interactions. Contrary to hypotheses, girl-girl dyads showed significantly higher observational positive friendship quality than boy-boy dyads, an effect that remained robust across sensitivity analyses. Questionnaire measures did not consistently differentiate boy-boy and girl-girl dyads, although sensitivity analyses among "close" and "best" friends suggested higher child-reported positive friendship quality in girl-girl dyads. Mixed-gender dyads generally did not differ from either same-gender group, but these contrasts were underpowered. Findings suggest that gendered friendship patterns among children with ADHD may more closely resemble those observed in neurotypical samples than expected. Results underscore the value of multi-method, multi-informant assessment and highlight the need for further research on friendships among girls with ADHD.

Research on child and adolescent psychopathology

Attention Deficit Disorder with Hyperactivity


Caste-specific nutritional signatures: Comparative physicochemical characterization of royal, worker, and drone jelly and larvae across developmental stages in Apis mellifera L

Abstract: Differentiation between honey bee castes is essentially a nutritional phenotype, but the complex physicochemical inputs that play critical roles in endocrine and epigenetic programming are still poorly documented, particularly for worker jelly (WJ) and drone jelly (DJ), which are rarely characterized alongside royal jelly (RJ) and the larvae that metabolize them. Here, we compare RJ, WJ and DJ and queen (1-4 d), worker (1-5 d) and drone (1-6 d) larvae produced under standardized field conditions (15 colonies) in Ordu, Türkiye (18 biological groups) systematically with respect to caste and age. Moisture/dry matter and ash were determined gravimetrically, protein by Dumas combustion, sugars and 10-hydroxy-2-decenoic acid (10-HDA) using HPLC (RID/UV), minerals and heavy metals by ICP-MS, and acidity based on pH and titration. RJ complied with international composition standards: protein (12.90%) and 10-HDA content at the authenticity threshold (1.41%). WJ exhibited elevated protein (16.80%) and the highest titratable acidity (48 mL 1 N NaOH/100 g), alongside relatively enriched macro- and microelement profiles, particularly K and Mg, providing a distinguishing nutritional "signature" of larval foods; DJ showed the highest protein density of all matrices (18.37%). Sugar profiles suggested that glucose and fructose predominated, but a strong developmental pattern for sucrose became clear: large amounts of sucrose were present in 1-day-old larvae but absent from all later developmental stages, consistent with rapid turnover of the carbohydrate pool during early growth. RJ was the most acidic matrix (pH 3.96), and pH increased with larval age across castes suggesting buffering, tissue growth and remodelling in the context of aligned biomass accumulation. Together, these data establish comparative baseline datasets for caste-related larval foods and larvae, reinforce authenticity quality-control frameworks beyond RJ alone, and furnish a physicochemical basis for mechanistic studies linking food chemistry with caste-linked developmental physiology. These baseline data also offer practical reference points for veterinary monitoring of larval nutrition and colony health. Beyond providing a comprehensive reference dataset, the divergent nutritional profiles we observed particularly in protein, sugar, and 10-HDA dynamics suggest that the temporal coordination of these components may contribute to the canalization of caste-specific developmental pathways.

Okuyan S
Çakici N
Şahin P
Şahin AE
Demir T
Sansar S
Alparslan S
Solmaz S
Arigül M
Sevin S

Animals
Bees
Royal Jelly
Fatty Acids
Larva