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Global practice patterns of sentinel lymph node biopsy in endometrial cancer: a survey from the European Network of Young Gynecologic Oncologists (ENYGO).
No full textOBJECTIVE: This survey aimed to evaluate trends in sentinel lymph node (SLN) biopsy for endometrial cancer among members of the European Society of Gynecologic Oncology (ESGO) and the International Gynecologic Cancer Society (IGCS). METHODS: We conducted an online cross-sectional survey among gynecologic oncologists over 40 years of age consisting of 30 questions. It was distributed to ESGO and IGCS members via Survey Monkey and Qualtrics between September and December 2022. Surveys were excluded in the analysis if >50% of questions were incomplete. Statistical analysis, performed with SPSS version 27.0. RESULTS: A total of 302 (70.2%) of 430 participants completed the survey, with 159 (52.6%) affiliated with ESGO and 143 (47.4%) with IGCS. The majority were male 206 (68.2%), and 170 (56.3%) were based in Europe. Most respondents (n = 261, 86.4%) were certified gynecologic oncologists. Indocyanine green was the most common tracer used (n = 234, 77.5%), with higher rates of blue dye injections among IGCS respondents (p = .002). The predominant injection volume was 4 cm3 (51%, n = 154). Most respondents (n = 232, 76.8%) used a combined superficial and deep ectocervical injection technique, with a higher proportion of superficial injections alone in the IGCS respondents (25.9% vs 11.9%, p = .003). Nearly half of the respondents (44.4%, n = 134) started SLN mapping at the uterine artery and continued dissecting laterally. In cases of mapping failure, 77.5% (n = 234) opted for side-specific lymphadenectomy. The Memorial Sloan Kettering Cancer Center algorithm was followed by 69.5% (n = 210), with 45.7% (n = 138) routinely using ex-vivo green fluorescence or gamma counter measurements. Finally, there was a higher adoption of immunohistochemistry for SLN ultra-staging in ESGO (n = 116, 73%) compared to the IGCS respondents (n = 94, 65.7%), (p = .047). CONCLUSIONS: This study showed significant variations in SLN biopsy practices for endometrial cancer, underscoring the need for global standardization through harmonized guidelines, consistent training, and international collaboration to improve staging accuracy and patient outcomes
DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk-multicentre retrospective study.
Full text linkINTRODUCTION: Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all malignancies. Emerging trends of association with risk factors such as diverticulitis highlight the need for updated screening and follow-up protocols. We aimed to examine risk factors associated with the development of CRC within 12 months following an episode of acute diverticulitis, and identify areas to streamline follow-up. METHODS: We performed a retrospective multicentre study of adult patients admitted in 2022 with computed tomography (CT) confirmed acute diverticulitis across four large NHS Trusts in the UK. Patient demographics, comorbidities, clinical presentation, vital signs, laboratory results, details of in-patient stay, and follow-up investigations were collected and analysed. Our primary outcome was the incidence of CRC within 12 months of index presentation with acute diverticulitis. Analysed secondary outcomes were potential patient risk factors associated with a diagnosis of CRC and follow-up protocols. All statistical analysis was performed using R (version 4.4) and P-values of < 0.05 were considered statistically significant. RESULTS: A total of 542 patients with acute diverticulitis over the study period were included. The median age of our cohort was 62 (51-73) years, and 204 (37.6%) were male. Ten (1.8%) patients were diagnosed with CRC within the 12-month period. Hinchey grade Ib was significantly associated with CRC (OR 4.51, P = 0.028). Colonoscopic follow-up requests were associated with age between 40 and 60 years, mild white cell count (WCC) elevation, and a hospital stay of 3-7 days. Male gender, age between 18 and 40 years, and elevated C-reactive protein (CRP) were all strongly associated with CRC but not statistically significant. Follow-up was inconsistent with 53.7% of the cohort having luminal investigations. CONCLUSION: The incidence of CRC was in-keeping with published literature. Hinchey grade 1b was significantly associated with a subsequent CRC diagnosis. These findings emphasise the need for specialised radiological review of CT scans to detect underlying malignancy. Moreover, standardised follow-up protocols following an episode of acute diverticulitis are needed to avoid missing malignant lesions
3D printed titanium TPMS for personalised tibial bone implant
No full textAbstract: Porous titanium scaffolds offer hope for reducing stress shielding and encouraging new bone growth, moving the field closer to personalised load bearing implants. This study explores four triply periodic minimal surface (TPMS) tibial scaffolds informed by Gyroid (GSC), Lidinoid (LSC), Diamond (DSC), and Schwartz Primitive (SSC) unit cells. These scaffolds were made using Laser Powder Bed Fusion (L-PBF) 3D printing, with a targeted porosity of 60 % to closely match the mechanical behaviour of natural tibial bone. Mechanical testing of these scaffolds revealed an elastic modulus of 10.42 to 13.62 GPa and compressive strengths ranging from 209 to 393 MPa, meeting the requirements for load-bearing tibial implants. Multi-criteria decision-making (MCDM) methods, AHP and TOPSIS, were applied to evaluate the designs, considering four favourable factors of relative importance in the order porosity>yield strength>elastic modulus>ultimate strength. This analysis identified SSC scaffold featuring Schwartz Primitive architecture as the most promising candidate for load-bearing applications. The biological compatibility of these scaffolds was also found to be equally compelling. In vitro testing with U-2OS osteosarcoma cells confirmed high cell viability, underscoring the cytocompatibility of these TPMS designs and reinforcing their potential for biomedical applications. Together, these findings offer a path toward the use of titanium scaffolds in orthopaedics, setting the stage for further in vivo studies and a potential breakthrough in functional bone implant design
Evaluating the VaLiANT (Valued Living After Neurological Trauma) group intervention for improving adjustment to life with acquired brain injury : a pilot randomized controlled trial
Full text link© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives
License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduc tion in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. The
terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.There is a need for accessible rehabilitation that promotes meaningful participation, wellbeing, and adjustment to life with acquired brain injury (ABI). VaLiANT (Valued Living After Neurological Trauma) is an 8-week holistic group intervention that integrates Acceptance and Commitment Therapy (ACT) and cognitive rehabilitation techniques to support adjustment and meaningful reengagement in life. This Phase II pilot randomized controlled trial explored feasibility and preliminary efficacy signals to determine the viability of a larger trial. Adults (>3 months post-ABI) were randomly allocated to VaLiANT plus treatment-as-usual (TAU), or TAU waitlist-control, with assessments at baseline, post-intervention (8 weeks), and follow-up (16 weeks). Feasibility criteria included recruitment, dropout, outcome assessment completion, adherence, and delivery fidelity. Preliminary treatment effects were assessed on a range of adjustment-related outcomes using mixed linear models, proportions of reliable change, and minimal clinically important differences. 54 participants were recruited (M(age )= 50.6, M(years-post-injury) = 5.4) predominately with stroke (52%) and traumatic brain injury (22%). All feasibility criteria were met. Treatment effects were identified on measures of psychological distress, experiential avoidance, valued living, and self-identity, but not meaningful participation, quality-of-life, or wellbeing. A larger trial is viable but VaLiANT will benefit from refinement first to improve its impact on all intended outcomes.Trial registration: ACTRN12619001243101.https://www.tandfonline.com/doi/10.1080/09602011.2025.2476074?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubme
The effect of a single session of transcranial direct current stimulation on attention in pediatric acquired brain injury : characterizing interindividual structural and functional network response variability
No full text2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).BACKGROUND: Approximately one in four children who sustain an acquired brain injury (ABI) have attention difficulties impacting education, employment, and community participation. These difficulties arise from dysfunction in attention-related brain networks, incentivizing the use of transcranial direct current stimulation (tDCS). We investigated whether a single tDCS session improved attention following childhood ABI and whether baseline structural connectivity (sc), functional connectivity (fc), attention, and/or simulated electric fields (E-fields) explained variability in response. METHODS: In a randomized, single-blind, within-subject, sham-controlled trial, 15 children with ABI (mean 12.7 years) and 15 healthy controls (HCs) received three single tDCS sessions (1 mA dorsolateral prefrontal cortex [dlPFC], 1 mA inferior frontal gyrus [IFG], sham; 20 min) during gamified attention training. We examined postintervention changes in attention according to flanker and stop signal reaction time (RT). We used multimodal analyses (high-density electroencephalography [HD-EEG], diffusion tensor imaging, magnetic resonance imaging) to investigate interindividual variability in tDCS response, according to associations between RT change and baseline fc, sc, attention, and E-fields. RESULTS: Although no effect of active versus sham tDCS was found overall, participants with lower theta or higher gamma default mode network connectivity and poorer attention at baseline showed greater response to tDCS. Higher E-fields were associated with greater response. No serious adverse effects occurred. CONCLUSIONS: A single tDCS session targeting dlPFC or IFG did not improve attention following pediatric ABI. We demonstrated how HD-EEG source-based connectivity may be used to personalize tDCS. Future research should explore whether personalization and/or repeated tDCS sessions can improve attention following pediatric ABI.https://www.pedneur.com/article/S0887-8994(25)00171-7/fulltex
Effectiveness of peer support for people with severe mental health conditions in high-, middle- and low-income countries : multicentre randomised controlled trial
Full text linkBACKGROUND: Some trials have evaluated peer support for people with mental ill health in high-income, mainly English-speaking countries, but the quality of the evidence is weak. AIMS: To investigate the effectiveness of UPSIDES peer support in high-, middle- and low-income countries. METHOD: This pragmatic multicentre parallel-group wait-list randomised controlled trial (registration: ISRCTN26008944) with three measurement points (baseline and 4 and 8 months) took place at six study sites: two in Germany, and one each in Uganda, Tanzania, Israel and India. Participants were adults with long-standing severe mental health conditions. Outcomes were improvements in social inclusion (primary) and empowerment, hope, recovery, health and social functioning (secondary). Participants allocated to the intervention group were offered UPSIDES peer support. RESULTS: Of the 615 participants (305 intervention group), 337 (54.8%) identified as women. The average age was 38.3 (s.d. = 11.2) years, and the mean illness duration was 14.9 (s.d. = 38.4) years. Those allocated to the intervention group received 6.9 (s.d. = 4.2) peer support sessions on average. Intention-to-treat analysis showed effects on two of the three subscales of the Social Inclusion Scale, Empowerment Scale and HOPE Scale. Per-protocol analysis with participants who had received three or more intervention sessions also showed an effect on the Social Inclusion Scale total score (β = 0.18, P = 0.031, 95% CI: 0.02-0.34). CONCLUSIONS: Peer support has beneficial impacts on social inclusion, empowerment and hope among people with severe mental health conditions across diverse settings. As social isolation is a key driver of mental ill health, and empowerment and hope are both crucial for recovery, peer support can be recommended as an effective component of mental healthcare. Peer support has the potential to move global mental health closer towards a recovery- and rights-based orientation.https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/effectiveness-of-peer-support-for-people-with-severe-mental-health-conditions-in-high-middle-and-lowincome-countries-multicentre-randomised-controlled-trial/12B11F541341A894771EE76B7695F4B
Time to prioritise the use of participatory research methods for people with intellectual disabilities
No full textPeople with intellectual disability experience significant health inequality, and consequently poor health outcomes. Although research can facilitate change, there is a risk of researchers propagating inequity by selecting methods that exclude people with some forms of intellectual disability. We argue for participatory research methods that enable inclusion.https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/time-to-prioritise-the-use-of-participatory-research-methods-for-people-with-intellectual-disabilities/597E3F8DD9E7F4678AD88A35C9C96A8
Understanding youth online experiences and mental health : development and validation of the digital activity and feelings inventory (DAFI)
Full text link© 2025 The Author(s). International Journal of Methods in Psychiatric Research published by John Wiley & Sons Ltd.OBJECTIVES: We created the Digital Activity and Feelings Inventory (DAFI) to measure youth digital activities and the psychological reactions they evoke, established its psychometric properties and tested its validity in predicting mental health relative to screen time estimates. METHODS: An initial pool of items was generated using the existing research on youth digital activity and mental health and further refined via consultations with experts and young people (online youth panel sessions, n = 14). The participants (n = 383, mean age = 19 years) completed the resulting DAFI alongside established measures of depression, anxiety, wellbeing, and screen time. The DAFI factor structure, reliability and predictive validity were tested. RESULTS: Exploratory factor analyses identified five digital activity subscales: Risky Content, Risky Interactions, Social Comparison, Leisure Activities and Social Engagement and three psychological reactions subscales: Negative Self-Reactions, Negative Stress Reactions, and Positive Reactions. Internal consistency and test-retest reliability were high. Social Comparison and Negative Self-Reactions, but not screen time, independently predicted depression and anxiety symptoms. Positive Reactions, lack of Negative Self-Reactions, lower screen time and Social Engagement predicted wellbeing. CONCLUSION: The DAFI is a reliable measure of digital activities and associated psychological reactions and predicts youth mental health better than screen time.https://onlinelibrary.wiley.com/doi/10.1002/mpr.7002
Randomized Control Trial Comparing Effects of Tourniquets on Neurology and Functional Outcomes after Total Knee Arthoplasty
Full text linkAbstract: Introduction: Total knee arthroplasty (TKA) often uses a tourniquet to enhance surgical visualization and reduce intraoperative blood loss. Despite its benefits, tourniquet use is associated with several complications such as skin blistering, nerve palsy, and deep vein thrombosis. The literature reveals a divided opinion on whether TKA should be performed with or without a tourniquet, with conflicting results on post-operative pain, blood loss, and functional outcomes. Materials and Methods: This study included patients aged 65 to 90 years undergoing elective unilateral TKA for osteoarthritis. Exclusion criteria included patients with a Body mass index ≥35, rheumatoid arthritis, peripheral vascular disease, diabetes, prior knee surgery, and on anticoagulation medication. The study focused on comparing the neurology through nerve conduction studies and functional outcomes of TKA performed with and without a tourniquet. Some key metrics included intraoperative blood loss, surgical duration, post-operative pain, analgesic use, and range of motion (ROM). Results:The study recruited 55 patients aged ranging from 65 to 90 years who were randomized into two groups.22 patients were excluded, and the final analysis involved 23 patients. Tourniquet use resulted in lower blood loss (140 mL vs. 215 mL) and shorter operative times (87 min vs. 95 min) compared to the non-tourniquet group. However, the tourniquet group had higher incidences of nerve palsy in the immediate post-operative period as compared to the other group. Both the groups showed significant improvements in post-operative ROM, but the tourniquet group had higher post-operative pain and analgesic requirements, and this was statistically significant. Conclusion: Tourniquet use in TKA reduces intraoperative blood loss and operative time but is associated with a higher risk of nerve-related complications and increased post-operative pain. The findings suggest that avoiding tourniquet use may lead to better overall clinical outcomes and early post-operative ROM
Barriers and facilitators for implementing music interventions in care homes for people with dementia and depression : process evaluation results of the multinational cluster-randomized MIDDEL Trial
Full text linkA process evaluation was embedded in the multinational Music Interventions for Dementia and Depression in ELderly care (MIDDEL) trial to better understand barriers and facilitators for implementing music-based interventions (MBIs). Stakeholders from 66 care home units across 5 countries completed a survey at baseline (n = 229) and after a six-month intervention period (n = 101), comparing expectations and experiences between countries, intervention groups, and stakeholders. MBIs were evaluated and found to be relevant and feasible. Barriers include a lack of support, turnover among employees, and a lack of motivation. Facilitators include individual stakeholders who proactively facilitate and stimulate implementation, as well as the presence of stable, well-functioning teams, clear communication, and adhering to project plans. Fewer barriers than expected related to care staff workload and the time needed for implementing new MBIs in care homes. MBIs can be beneficial for people with dementia, yet implementation in care homes can be challenging due to contextual factors. Involving stakeholders in key positions is essential: care home managers are pivotal for policy-making and the sustainable adoption of MBIs, whereas the commitment and the involvement of care staff are needed for day-to-day implementation. Insight into these barriers to and facilitators of implementation can contribute to the interpretation of trial results.https://www.mdpi.com/2076-328X/15/8/100