Retirement from sport is a life transition that has significant implications for athletes’ physical and mental health, as well as their social and professional development. Although extensive work has been done to review the retirement experiences of athletes, relatively less work has been done to examine and reflect on this expansive body of literature with a pragmatic aim of deciding what needs to happen to better support retiring athletes. This study used scoping review methodology to review current academic reviews, gray literature articles, and support programs on athletic retirement. This review followed the Joanna Briggs Institute reviewer’s manual guide on scoping reviews and adhered to the PRISMA-ScR checklist. Academic articles were identified from PubMed, Embase, Web of Science and Scopus. Gray literature articles and support programs were identified using advanced Google searches. This study identified 23 academic reviews, 44 gray literature articles, and 15 support programs. Generally, the results suggest that athletic retirement encompasses a drastic shift in identity, a loss of social networks, a lack of career ambitions, and potential risks to physical and mental health. While there was a gap in the academic literature regarding practical strategies to support retiring athletes, the gray literature suggests many creative ideas. Stepwise programming may be beneficial to help athletes: (a) make sense of their athletic experience and see retirement as an ongoing process; (b) develop a well-rounded sense of self identity and understand how to apply their unique skills and strengths in new ways; (3) gain control over their retirement transition by establishing a clear plan and adjusting to new routines and opportunities; and (4) normalize the transition experience by “living in the next” and building confidence in new life directions. Future research may benefit from developing and evaluating more programming to support athletes through the retirement transition. Retirement from a high-performance sport is a life transition that has significant implications for physical and mental health, as well as social and professional development . AthletiReviews of the academic literature on athletic retirement have generated mixed findings regarding the impact of retirement from sport on mental and physical health , 11, 12.Several approaches can be used to examine individuals’ retirement experiences, including approaches from the field of social gerontology where retirement is seen as a career transition that results in the termination of paid work –26, and Regardless of the approach taken, there appears to have been extensive work done to review the retirement experiences of athletes in both academic and non-academic settings. Despite these important advancements, relatively less time has been taken to examine and reflect on the expansive body of literature, with a pragmatic aim of deciding what needs to happen next to better support retiring athletes. Despite numerous evidence syntheses, athletes still face physical, mental, and emotional struggles after retirement with a lack of appropriate supports. Though nearly every move an athlete makes is scrutinized, relatively little attention is paid to an athlete’s transition to life after sport. In light of the current state of the literature, this review presents a scoping review of the athlete retirement transition experience, focusing on existing reviews of the academic and gray literature, with a pragmatic aim to improve future practices.The objective of this scoping review is to review other academic reviews, gray literature articles, and support programs that address athletes’ experience transiting into life after sport, with a pragmatic aim of identifying how athletes can be supported through the retirement process. To encompass a wide range of athlete experiences, this review includes both amateur and professional athletes. This review will address the following specific questions: (1) what are the main characteristics of academic and gray literature studies that review athletes’ transition experiences? (2) what does the current body of synthesized literature say about the key barriers and enablers to a successful athletic retirement transition? (3) what does the current body of synthesized literature say about the negative and positive impacts of athletic retirement? and (4) what does the current body of synthesized literature say about the programming needed to better support athletes’ transition into life after sport?other reviews as our primary evidence source [We followed the Joanna Briggs Institute reviewer’s manual guide on scoping reviews, with a focus on e source . We wante source .rd, 2022, with search terms related to athletes, retirement, and reviews. Results were limited to English. We ensured our search was specific enough to yield highly relevant reviews we knew we wanted to include. To find relevant gray literature sources, several targeted advanced Google searches were conducted between August and September 2022. The advanced Google searches included search terms related to athletes, retirement, and organizations that our research team identified as highly relevant . For pragmatic reasons, only the first 50 sources  were used for each advanced Google search. Our full search strategy can be viewed in The search strategy was developed by the lead authors (PV and MS). To find relevant academic sources, a search of the databases PubMed, Embase, Web of Science and Scopus were conducted on July 23For our academic search, included papers were restricted to full-text, original, peer-reviewed evidence syntheses . The reviews had to focus on athletes as their primary population . We decided to include amateur and professional athletes to encompass the wide range of athletes who experience the retirement transition process. The reviews also had to have a clear focus on athletes’ retirement or transition into life after competitive sport . Although we did not constrict our paper eligibility by the type of review, the review had to include a clear search strategy . For our gray literature search, advanced google searches either identified: (a) programs that support athlete transitions, or (b) non-academic articles about athlete transitions. No restrictions were put on the date or location of included sources, although certain search terms focused on American and Canadian programs specifically.Reviews from the academic database searches were handled using Covidence  reference management software. Reviews were deduplicated and imported for a 2-level screening process. During level 1 screening, titles and abstracts were double screened by two reviewers (AR and LA) using the eligibility criteria. Publications with titles and abstracts not meeting the eligibility criteria were excluded. During level 2 screening, full-text papers that passed level 1 were screened by the same two reviewers (AR and LA). Studies that met the eligibility criteria were included for full data extraction. Discrepancies during level 1 and 2 screening were discussed over several meetings with final decisions on screening made by PV. Programs and articles from the gray literature search were handled using google sheets. One reviewer (JC) scanned the advanced google searches for relevant programs and articles using the eligibility criteria. The reviewer copied and pasted relevant programs and articles into a google sheet, which was then reviewed by PV. After discussion between JC and PV on the included programs and articles, the final gray literature source inclusion was finalized by PV.Data from the included academic reviews were extracted using a data extraction form that included information on reviews’ title, author, year, journal, review type, study objective, databases searched, date range searched, population limitations, setting limitations, number of papers included, paper types included , paper locations, paper populations , and the key thematic constructs identified in the review. The thematic information we extracted included information on (a) the barriers and enablers of athlete retirement transitions, and (b) the negative and positive outcomes of athletic retirement. Barriers to retirement transitions and negative outcomes after retirement were indicated using a negative text symbol  high athletic identity, or (-) worsening anxiety and depression). Enablers and positive outcomes were indicated using a positive sign  planned retirement, or (+) relief from pressure and expectation). The data was initially extracted by one reviewer (IH) and then reviewed and refined by the lead authors (MS and PV).articles were extracted using a data extraction form that included information on the title, author, host origination, organization mission, organization location, key themes about (a) athletes’ unique experiences, (b) athletes transition challenges and enablers, and (c) strategies or programs for improving the transition experience. Data from included gray literature programs were extracted using a data extraction form that included information on the title, author, host origination, organization mission, organization location, and the program’s offerings for athletes . The data was initially extracted by one reviewer (JC) and then reviewed and refined by the lead authors (MS and PV).Data from included gray literature sources  were extracted using two different data extraction forms. Data from the gray literature The lead author (PV) completed a descriptive analysis of the data collected from the included papers that aligned with the objectives of this review. For the academic sources, we start by presenting an overview of the review characteristics. We then present a summary of the major findings across the reviews depending on the review topic  reviews that explore the general psychosocial experiences of retiring athletes, (b) reviews that specifically explore the cognitive and mental health experiences of retiring athletes, and (c) reviews that specifically explore the musculoskeletal and cardiovascular experiences of retiring athletes. For the gray literature sources, we first present an overview of the gray literature source characteristics. We then present a summary of the major themes across the gray literature sources, including summaries about (a) the unique experiences of athletes themselves, (b) athletes’ experiences with retirement, specifically, and (c) support programming for retiring athletes. All reviews were published in the last 10 years (between 2013–2022). In total, 10 reviews explored the general retirement experiences of athletes, 8 reviews explored athletic retirement with concussion, cognitive, and mental health concerns, and 5 reviews explored athletic retirement with musculoskeletal and cardiovascular health issues. The majority of the reviews were systematic reviews (n = 20), in addition there was a scoping review (n = 1), a critical review (n = 1), and a literature review (n = 1). Most reviews combined athletes from multiple different sports (n = 14); the remaining reviews focused on soccer players (n = 5), cricket players (n = 1), rugby players (n = 1), American football players (n = 1), and gymnasts (n = 1). Most reviews included athletes from multiple countries (n = 21), however, 2 reviews specifically focused on athletes in the United States. The number of articles examined in each review ranged from 4 articles to 219 articles, with the mode being 17 articles. Most reviews included male and female participants (n = 15), with the exception of reviews that focused on females only (n = 1), males only (n = 3), or did not report on gender (n = 4). Most reviews focused on quantitative studies (n = 16); however, several reviews included multiple study designs (n = 5). Only 1 review did not report the designs of the studies they included. The majority of reviews focused on professional and elite athletes (n = 11); several reviews featured sub-elite athletes (n = 6), such as club or high school athletes, and a substantial number of reviews did not report the level of the athletes in the studies included (n = 7).We identified 23 academic reviews of literature examining the retirement transitions of athletes. A detailed description of the academic reviews included in this overarching review is provided in the Among the 10 reviews that explored the general retirement experiences of athletes, we identified numerous barriers and facilitators that affected athletes’ ability to smoothly transition into life after sport. Barriers included: (1) having a high athletic identity; (2) high perfectionism and comparison; (3) athletic career dissatisfaction; (4) involuntary retirement ; (5) amount of other life changes occurring at the same time as retirement; (6) despair about future career; (7) lack of coping strategies; (8) low social support; (9) lack of transition planning; (10) education and resource dissatisfaction; (11) previous concussions; (12) raising body mass index; and (13) onset of osteoarthritis. Facilitators included: (1) having a good sport-life balance ; (2) positive self-perception and self-control; (3) athletic career satisfaction; (4) voluntariness of retirement; (5) gradual reduction of training; (6) length of time since retirement; (7) retirement planning; (8) support program involvement; (9) planned occupation after retirement ; (10) educational attainment; (11) financial planning; (12) social support network; (13) continued relationships with coaching staff; (14) strong coping strategies  crisis preparedness.In addition to barriers and facilitators that affected athletes’ retirement transition, we also identified numerous negative and positive impacts of athletic retirement itself. Negative impacts included: (1) worsening anxiety and depression; (2) feelings of burnout; (3) feelings of grief, loss, and void; (4) sleep disturbance and distress; (5) adverse alcohol use; (6) adverse smoking behaviours; (7) brain atrophy and dementia; (8) difficulty establishing new a lifestyle routine; (9) adverse nutrition behaviour; (10) disordered eating; (11) body dissatisfaction; (12) compensatory exercise; (13) high incidence of osteoarthritis incidence; (14) high incidence of join pain/back pain; and (15) high incidence of skin cancers. Positive impacts included: (1) relief from pressure and expectation; (2) high capacity for resilience and toughness; (3) greater or similar long-term quality of life; (4) greater capacity in certain mental proficiencies; and (5) difficulties with transition will fade over time.Among the 8 reviews that explored the relationship between athletic retirement and cognitive or mental health outcomes, several reviews examined and found that history of concussion during sport was a significant risk factor for cognitive impairment  and mental health issues among retired athletes. Only one review reported mixed findings about this association . Most reAmong the 5 reviews that explored the relationship between athletic retirement and musculoskeletal and cardiovascular health issues, 4 reviews specifically focused on osteoarthritis prevalence among retired athletes, while 1 review focused on cardiovascular disease risk . Among tS3 and We identified 15 unique programs from our gray literature search that provide information about support for athletes through their athletic retirement transition. In addition, we identified 44 unique non-academic articles that describe and provide practical advice on athletic retirement transitions. Athlete retirement transition programs were based in different regions including, Canada (n = 7), the United Kingdom (n = 2), the United States (n = 2), Australia (n = 1), and South Africa (n = 1); while some programs had a clear global presence (n = 2). A full description of the programs and articles we identified in the gray literature search can be viewed in the Based on our analyses of the gray literature, 10 features emerged as unique aspects of the athlete experience: (1) living in a highly structured environment ; (2) living in a high pressure and stimulating environment ; (3) athletics is experienced as a way of life ; (4) high identity association with being an athlete ; (5) young career termination ; (6) high focus on body function and image ; (7) experiencing injury and/or significant bodily changes ; (8) large personal sacrifices during their career ; (9) unique financial situations ; and (10) gaining distinctive skillsets that can be transferable to other life circumstances .In terms of the athletic retirement transition, 10 key challenges and 5 key opportunities emerged from the gray literature. Challenges include: (1) athletic termination as a crisis ; (2) athletic retirement as a long process, not a quick event ; (3) loss of identity ; (4) lack of purpose in day-to-day life ; (5) lack of stimulation and psychological demands ; (6) loss of significant relationships ; (7) physical adaptations ; (8) financial concerns ; (9) mental health issues, ; and (10) substance use concerns. Athletes’ transition opportunities relate to: (1) exploring new social networks and lifestyle opportunities ; (2) exploring other career interests ; (3) having the chance to unwind ; (4) the stamina and strength gained in athletics ; and (5) being psychologically disciplined and accountable .Factors that influence whether an athlete has a positive or negative transition experience were found to be context dependent and related to issues such as: (1) voluntariness of retirement; (2) timing of retirement; (3) duration of the transition; (4) amount of other life changes during retirement; (5) positive or negative reflections on athletic career; (6) financial and career planning for retirement; (7) fitness and dietary planning for retirement; (8) personal brand built through athletics; (9) high athletic identity association; (10) ongoing injury issues; and (11) prioritization of retirement planning.The primary themes that emerged in relation to athlete retirement transition supports include the deliverer of support, the receiver of support, the delivery mode of support, and the content of support. Regarding the deliverer of the support, many different groups provided athletes with support, including: (1) athletic organizations; (2) third-party organizations ; (3) sports psychologists and counsellors; (4) family, friends, mentors, and peers; and (5) coaching staff and other team personnel . Regarding the receiver of supports, many different groups also accepted support, including (1) athletes themselves; (2) coaching staff; (3) athletic organizations; and (4) parents, family, friends, and partners. Regarding the delivery mode of support, avenues tend to be resource-based  or systems-based . Resource-based supports include: (1) resource repositories; (2) educational information; (3) employment lists; (4) extracurricular activities lists; (5) educational opportunities lists; (6) videos with education/advice; (7) podcasts sharing lived experiences; (8) speaker series sharing lived experiences; (9) social media stories; (10) assessment tools; (11) reflection workbooks; and (12) guided journaling. Systems-based provisions include: (1) person-to-person support (online or in-person); (2) email or text-based support; (3) stepwise multicomponent programming; (4) team-integrated programming; (5) small group workshops; (6) membership to a community network; and (7) conferences or retreats. Regarding the content of support, the following issues were addressed: (1) personal wellbeing; (2) identity shifting; (3) mental health; (4) social networks; (5) personal relationships; (6) career building; (7) educational development; (8) physical health; (9) diet and exercise; (10) financial planning; (11) stories about others lived experiences; (12) education about transitioning; (13) personalized sports psychology; and (14) stepwise programming.S5 Table.Stepwise programming tended to include multifaceted interventions that featured the following steps: (1) come to terms with their retirement and see the retirement transition as a process; (2) develop a well-rounded sense of self identity and understand how to apply their unique skills and strengths in a new setting; (3) gain control over their retirement transition by establishing a future plan and adjusting to new routines and opportunities; and (4) normalize the transition experience by “living in the next” and building confidence in new life direction. The contents of these steps have been fully detailed in high athletic identity is consistently associated with difficulties in transitioning into life after sport. Among elite athletes, it is not uncommon for their social networks, career ambitions, physical goals, psychological stimulation, and sense of self-worth to be distinctly tied to their sport [This paper presents a scoping review of the synthesized academic and gray literature regarding athlete retirement transitions. Our analyses of review articles from the academic literature illustrate that possessing a ir sport , 36. It ir sport , 44. Their sport , 45.ended their career on a low . In line with prior research [strong athletic identity combined with a traumatic career termination puts athletes in a very difficult scenario early in their lives [In addition to the challenge of athletic identity, the academic literature highlighted an important threat for athletes who research , 46, 47,ir lives . In lineir lives –51, thishealthy sport-life balance over the course of their athletic career can better transition into life after sport. Developing interests outside of sport and making time to develop contingency plans for life after sport helped ameliorate the transition. A second notable enabler was that athletes who can gain a sense of perceived control over their athletic termination, and gradually reduced their athletic participation, are able to transition better into retirement. Although supporting athletes to maintain balance, plan for their retirement, and gradually detrain themselves may seem counterintuitive to sports organizations who want the most out of their current athletes, our paper indicates that athletes who plan for retirement may actually perform better while still competing.Although identity loss, career regret, and abrupt lifestyle modifications were common conditions among retiring athletes, several key factors emerged across the academic literature as enablers of positive retirement transitions. The first notable enabler was that athletes who create a While much attention has been placed on the need to enhance athlete mental health and wellbeing , 53, lescognitive impairment, mental health issues, and osteoarthritis complications [Across the synthesized literature is a consensus that retiring athletes are at a particularly high risk of experiencing ications , 7, 36. a wide range of supports from different sources in order to address different needs. Stepwise programming, where athletes work through a series of ongoing interventions to prepare for a retirement transition, emerged as a robust enabler of a positive transition experience. Gradual, longstanding, embedded investments into retirement planning may be highly advantageous for improving athlete retirement transition outcomes. Researchers and practitioners may deeply benefit from investigating the mechanisms that best support the development of a well-rounded sense of self throughout an individual’s athletic career and through the retirement transition experience.Despite indicating that retirement planning facilitated a better transition to athletic retirement, a clear gap in the academic literature exists with regard to how to develop and implement specific strategies for retirement planning based on sport and level. Fortunately, much of the gray literature focuses on these specific details, suggesting a multitude of creative ideas for how to better support athletes transition into life after sport. What is clear across the gray literature is that athletes need This review is the first of its kind to examine existing review articles from academic literature as well as current evidence from gray literature on retirement from sport. Limitations of this review include that we only included studies published in English and therefore may have excluded potential studies published in a different language. In an effort to be inclusive of the existing literature on athletic retirement, our review incorporates reviews of studies that combine different types of sport, multiple geographic regions, individuals of varying gender, and combines data on professional as well amateur athletes. Retirement experiences are likely to differ based on factors like these. Future research may benefit from focusing on developing and evaluating retirement support interventions based on characteristics of the individual athlete, the sport, as well as regional variations and other contextual factors.This review scopes the current synthesized academic and gray literature on athlete retirement transitions, with a pragmatic focus on how retiring athletes can be better supported. We identified and examined 23 academic reviews of literature examining the retirement transitions of athletes, 15 unique programs from gray literature that aimed to provide information about support to athletes through their athletic retirement transition experience, and 44 distinct non-academic articles that described and provided practical advice on the athletic retirement transition. The literature illustrates that feelings of loss, identity crisis, career regret, and difficulties with abrupt lifestyle modifications are common experiences in an athlete’s retirement transition. While the academic review literature presented a gap in evaluating programs that aim to ameliorate athletic retirement, the gray literature provided multiple creative ideas for how to improve programming to support athletes’ transition into life beyond sport.S1 Checklist(PDF)Click here for additional data file.S1 Table(DOCX)Click here for additional data file.S2 Table(DOCX)Click here for additional data file.S3 Table(DOCX)Click here for additional data file.S4 Table(DOCX)Click here for additional data file.S5 Table(DOCX)Click here for additional data file.


We review the latest information related to the control of fruit softening in tomato and where relevant compare the events with texture changes in other fleshy fruits. Development of an acceptable texture is essential for consumer acceptance, but also determines the postharvest life of fruits. The complex modern supply chain demands effective control of shelf life in tomato without compromising colour and flavour.Solanum lycopersicum) are discussed with respect to hormonal cues, epigenetic regulation and transcriptional modulation of cell wall structure-related genes. In the last section we focus on the biochemical changes closely linked with softening in tomato including key aspects of cell wall disassembly. Some important elements of the softening process have been identified, but our understanding of the mechanistic basis of the process in tomato and other fruits remains incomplete, especially the precise relationship between changes in cell wall structure and alterations in fruit texture.The control of softening and ripening in tomato ( Solanum lycopersicum) and other fruits is essential to the successful function of the modern fresh market supply chain. Substantial losses during transportation, susceptibility to post harvest diseases and limited keeping quality, result from fruits that ripen and soften rapidly. This has led to the use of a range of natural ripening mutations in commercial tomato breeding that slow the ripening and softening processes. The best known of these is the ripening inhibitor (rin) mutation. The use of the rin mutation in commercial practice has been very important in extending tomato shelf life, but it has detrimental effects on colour and flavour  and downstream genes Fig. .Fig. 1HPlant hormones, such as ethylene, act as endogenous and exogenous cues that govern the transition stage from fruit development to ripening. Extensive studies have shown that fruit ripening is modulated by a complicated network of feedback and crosstalk among different phytohormones including ethylene, abscisic acid (ABA) and auxin  and ABA 8′-HYDROXYLASE (SlCYP707A2) genes, which are genes involved in ABA biosynthesis and catabolism, resulted in elevated pectin levels and improved texture and shelf life and several genes encoding major cell wall catabolic enzymes were down regulated , a gene which encodes an ABA receptor, has revealed a role for SlPYL9 in regulating ABA signalling and ripening in tomato by affecting expression of ripening-related genes involved in ethylene production and cell wall modification , β-GALACTOSIDASE (FaβGAL4) are positively regulated by ABA and negatively regulated by auxin , CELLULASE 1 (CEL1), and CELLULASE 2 (CEL2) were significantly up-regulated by ABA treatments, thus accelerating ripening in strawberry  within the QTL was cloned. This FIS1 gene encodes a GA2-oxidase, an enzyme that inactivates endogenous GAs and their precursors  also participate in modulating tomato fruit ripening via an interplay with ethylene. In several recent studies GA has been demonstrated to play a negative role in regulating tomato ripening. It is associated with suppression of the expression of ripening associated transcription factors and inhibiting ethylene production , and RNA methylation. Many of these events have now been shown to be associated with the progression of normal ripening and softening in tomato and other fruits  subfamily played a positive role in regulating fruit softening through the activation of the same set of cell wall related genes regulated by SlHDA1/3  proteins within the polycomb repressive complex act as repressors of gene expression via histone modifications , non-ripening (nor) and Colourless non-ripening (Cnr) , ENDO--Β-MANNANASE 4 (LeMAN4) and α-EXPANSIN 1 (LeEXP1), CEL2, XYLAN 1,4-BETA-XYLOSIDASE1 (XYL1)   was highly ripening-related. Repression of SlFSR significantly reduced the expression of multiple cell wall modification-related genes including PL, PG, TBG4, CEL2, XYL1, PECTIN ESTERASE (PE), MANNOSIDASE (MAN1), XYLOGLUCAN ENDOTRANSGLUCOSYLASE/HYDROLASE (XTH5) and EXP1, and prolonged shelf life, but did not influence other aspects of fruit ripening. These observations reveal the potential role of SlFSR in targeted control of tomato fruit shelf life by regulating cell wall metabolism  TF, SlLOB1 has been shown by Shi to act as a transcriptional activator of a broad suite of cell wall–related genes and to control softening  were direct targets of SlHY5. However, the interplay between SlHY5 and these regulators needs further investigation  in Arabidopsis  (Wang et al., In a similar way to the pectin domain, disassembly of the hemicellulose and cellulose domains in the wall also appear to be a common feature of ripening in tomato and other fruits, but the contribution of these events to texture changes is even less well understood (Posé et al., Cell wall enzymes and other factors - In both tomato and strawberry the expression of genes encoding enzymes with PL activity has been demonstrated to be important in softening of these fruits. In the absence of PL expression, tomato fruit softened more slowly and HG was retained at cell junctions in the pericarp (Uluisik et al., The action of PL on wall mechanical properties has been studied in onion cells. Here lateral mobility of cellulose microfibrils was greatly increased at the nm-scale after PL treatment. However, concomitant effects on wall loosening and tensile properties were absent (Zhang et al., EXP1 is silenced (Brummell et al., EXP1 expression alters the extent of pectin depolymersation (Brummell et al., EXP1 has been shown to be important in tomato softening and there is an inhibitory effect on the process when SlLOB1 (Shi et al., EXP1 are strongly suppressed in SILOB1 RNA interference lines and induced in SlLOB1-overexpressing fruits. Other cell wall-related genes that show related patterns of expression in the SlLOB1 lines included CEL2 which encodes an endo-β1,4-glucanase and genes encoding an alpha-xylosidase and a β-1,4 endomannase. As already mentioned, EXPs may enhance the ability of cellulase to act on cellulose microfibrils (Zhang et al., New insights into the mechanisms involved in cell wall disassembly are now coming from studies of ripening-related TFs. Shi investigated the genes impacted by suppressing or upregulating the expression of the TF


Dear Editor,1][. The 2019 Lancet paper by Colvin et al.5][. The United States Food and Drug Administration (orFDA) has issued a black-box warning for this class of drug in a setting ofCABG6][. Cardinale etal.11][ study. Markham et al.12][, and the way to which can only be paved by sustainableconcepts like multimodal analgesia.The opioid-sparing links of multimodal analgesia ought to be nurtured in the present eraof ERAS with a primary patientcentric approach of an enhanced recovery in cardiacsurgery While a traditionalist might argue fddling with the position that opioids haveenjoyed in the cardiac surgery, any degree of opioid stewardship materializes fromevidence in ERAS (an evidence-based augmented patient recovery)


In the original publication , ref. ,  corresponding microscopic model diagrams before and after growing VACNTs, respectively. Reprinted with permission from Elsevier 2023 [36].The citation has now been inserted in the caption of Figure 3 and should read: SEM images of CF: (a) adsorption and desorption curves; (b) the pore width. Reprinted with permission from Elsevier 2023 [36].The citation has now been inserted in the caption of Figure 4 and should read: BET analysis results [36] of CF with growing VACNTs in situ: (The authors apologize for any inconvenience caused and state that the scientific conclusions are unaffected. This correction was approved by the Academic Editor. The original publication has also been updated.


Myeloid sarcoma is a rare clinical entity that presents as an isolated proliferation of leukemic cells, concurrently with or at relapse of acute myeloid leukemia (AML), myelodysplastic syndromes/neoplasms (MDS), chronic myeloid leukemia (CML), and myeloproliferative neoplasm (MPN). Myeloid sarcoma disrupts the normal architecture of its surrounding tissues. When it forms in long bones, it can cause their pathological fracture. We recently experienced a rare case of MDS presenting with myeloid sarcoma in the femur that eventually resulted in its pathological fracture. Detailed chromosomal analysis of the bone marrow cells suggested emergence of myeloid sarcoma during the fast-paced progression of MDS just after acquiring trisomy 22. A comprehensive review of previous cases of myeloid sarcoma-associated pathological fracture indicated possible involvement of structural rearrangements of chromosomes 9 and 22. Management of myeloid sarcoma should continue to improve, and clinicians should note that myeloid sarcoma with specific chromosomal alterations needs extra medical attention to prevent pathological fracture. Myeloid sarcoma is a tumor mass consisting of myeloblasts with or without maturation involving any anatomical site. Most often, myeloid sarcoma is formed in patients with acute myeloid leukemia (AML), either at the time of diagnosis, during or after chemotherapy. This medical condition is well established in AML patients with recurrent genetic abnormalities, especially in cases of core binding factor AML that are characterized by the presence of either t8;21)  or inv(16)    scan was immediately taken, but did not locate any origins of fever. The complete blood counts showed white blood cells (WBC) of 6,700 /μL (13% neutrophils) and platelets of 1.02 × 10Myeloid sarcoma is a tumor composed of immature myeloid precursor cells. It sometimes develops as a de novo isolated sarcoma without bone marrow involvement . Besides, extensive review of the past literatures on myeloid sarcoma-associated pathological fractures, we have identified 18 cases that had been reported with description of the results of cytogenetic analyses. In a sharp contrast to the chromosomal alterations seen in myeloid sarcoma in general, our detailed review elucidated that the incidence of t in myeloid sarcoma with pathological fractures (8/19 cases) is considered to be much higher than expected. Thus, we suspect the potential yet vital role of chromosomes 9 and/or 22 alterations in the development of myeloid sarcoma-associated pathological fractures. Given that the present case developed myeloid sarcoma soon after the immature myeloid cells acquired additional chromosomal alteration of + 22 (Fig. As shown in Table 1In summary, we have experienced a rare case of MDS presented with a myeloid sarcoma in the right femur that eventually resulted in its pathological fracture. Reviewing the past cases, the possible involvement of the rearrangements of chromosomes 9 and 22 is suspected in the occurrence of myeloid sarcoma-associated pathological fractures. To seek the optimal management of myeloid sarcomas and prevention of associated complications, clinicians are encouraged to pay extra medical attention to the myeloid sarcoma cases involving chromosomes 9 or 22 alterations.


This cross-sectional study assesses the prevalence of conflicts of interest (COI) associated with guideline-recommended drugs among Infectious Diseases Society of America clinical practice guideline authors and compliance with the Council on Medical Specialty Societies and Institute of Medicine guidelines. The prevalence and nature of COI among authors of infectious diseases CPGs are poorly understood. We assessed the prevalence of COI associated with guideline-recommended drugs among Infectious Diseases Society of America (IDSA) CPG authors and compliance with Council on Medical Specialty Societies (CMSS) and Institute of Medicine (IOM) guidelines.5Conflicts of interest (COI) among clinical practice guideline (CPG) authors are commonSTROBE) reporting guideline and was determined to be exempt by the HealthPartners institutional review board because it was non–human participants research.In this cross-sectional study, we searched all IDSA CPGs from June 1, 2017, to March 31, 2022 (N = 37). We excluded guidelines not published primarily by IDSA (n = 17) and guidelines without recommendations regarding specific antimicrobials (n = 10). We identified all CPG authors, their status as chair or co-chair, disclosed relationships, and relationship time frames. We included relationships only with pharmaceutical companies that developed or sold drugs. We extracted all drugs recommended in each CPG and excluded drugs recommended only in a clinical trial or sold only outside the US. We searched US Food and Drug Administration websites to identify drug manufacturers and approval dates. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology  and a pharmaceutical company if the company manufactured a guideline-recommended drug at the time of publication. Companies associated with a manufacturer as a subsidiary or acquisition were included. Conflicts of interest described in the present tense were considered active relationships and categorized as high-level COI , for the analysis.We assessed the prevalence of COI and high-level COI and guideline compliance with the following IOM and CMSS recommendations: (1) most panel members are free of COI relevant to guideline subject matter and (2) panel chairs (or ≥1 chair if co-chairs) are free of COI relevant to guideline subject matter.Clostridioides difficile infection (CDI 2018) (21), and COVID-19 2021 (12)  disclosed a relationship with any pharmaceutical company, and one-third (48 of 149 [32.2%]) had 1 or more COI or high-level COI . The ant021 (12) . Most CP021 (12) . Four CP6 We also focused on the tense of disclosures in our analysis, which is vulnerable to misclassification. To ensure that IDSA CPGs remain a trusted source, improving the review and management process for CPG COI is needed.Relationships between IDSA CPG authors and the pharmaceutical industry are common. Approximately one-third of authors disclosed relationships with manufacturers of guideline-recommended drugs, and multiple IDSA CPGs were nonadherent to CMSS and IOM standards. Our findings warrant further attention considering that even the appearance of bias in CPGs can have negative consequences—public distrust in science and health care, including concerns about ties between clinicians and pharmaceutical companies, has been increasing. Study limitations are that we did not assess the accuracy of COI disclosures using third-party data, which may have resulted in underreporting of COI.


Antimicrobial stewardship programs (ASP) have demonstrated improvement in patient outcomes, reduction of antimicrobial adverse drug events (ADE) and a decrease in antimicrobial resistance in hospitals. Antimicrobials maintain the second highest rate of ADEs in long-term care facilities. Prescribed antimicrobials in nursing homes may be unnecessary or inappropriate in upwards of 75% of cases. There is limited evidence available quantifying the impact of pharmacist-led ASP interventions in long-term care facilities. The purpose of this project is to evaluate the effectiveness of antimicrobial stewardship interventions completed at the Salisbury Veterans Affairs Health Care System Community Living Center (SVAHCS CLC).® was proposed from May 2018 to January 2021. The primary objective is to determine the effectiveness of ASP interventions in the CLC based on acceptance rate. Secondary objectives include to assess safety of select implemented CLC ASP interventions through reported ADEs within 30 days of performed CLC ASP intervention and determine potential cost savings of the implemented ASP interventions.This is a retrospective quality improvement project. Eligible subjects included Veterans residing in the SVAHCS CLC to which an ASP intervention documented in TheraDocClostridioides difficile infection. There was a total potential cost savings of $101,704.A total of 379 interventions were included. Of these interventions, 370 were accepted (98%), 5 were accepted with modification (1%) and 4 were rejected (1%). The most common ASP interventions included lab monitoring, renal adjustment, pharmacokinetic consults and duration changes. The most common indications for many ASP interventions performed were osteomyelitis, influenza and bacteremia. Vancomycin, cefepime and ceftriaxone were the most common antimicrobials involved for which ASP interventions were performed. Of the 131 interventions assessed for safety, one Veteran experienced ADEs within 30 days of the intervention including nephrotoxicity and Most Common InfectionsASP Intervention Acceptance Rate and ADEs within 30 Days of ASP InterventionThis study demonstrates that pharmacist-led ASP interventions proposed in the SVAHCS CLC were effective with a high rate of acceptance. These interventions resulted in a low rate of ADEs and potential cost savings for the facility.All Authors: No reported disclosures


Nature reveals an interaction between SWI/SNF subunits and mitotic chromatin, which is essential for establishing gene bookmarks and preserving cell identity.1 The findings deepen our understanding of how SWI/SNF complexes regulate transcriptional memory heritability for cell fate commitment  and polybromo-associated BAF (PBAF) complexes that were found bound to mitotic chromatin.4 Like many transcription factors, SWI/SNF subunits are expected to be degraded during mitosis.3 It is thus reasonable that SWI/SNF subunits that interact with chromatin in dividing cells may have implications for their participation in fate commitment or propagation of transcriptional blueprint. This idea may have motivated the curiosity of Zhu and colleagues to interrogate how the inheritance of somatic phenotypes is underscored by the gene expression modulatory activity of SWI/SNF subunits that linger at mitosis.1The SWI/SNF or BAF complexes are chromatin remodelers assembled on a modular basis and in a context-specific manner to dictate gene expression patterns that influence cell state and function.1 employed a biochemical fractionation strategy to investigate the presence, subcellular localization, and interaction of SWI/SNF complexes with chromatin in synchronized mouse embryonic stem cells spanning the cell cycle. It was identified that SMARCB1 and SMARCE1 were bound to mitotic chromatin, whereas other SWI/SNF subunits, including SMARCA4 (Brg1), were disengaged or residually bound. They subsequently used live cell imaging to substantiate the observation by in situ visualization of mitotic chromatin localization of SMARCB1 and SMARCE1 alongside SOX2, a classic mitotic chromatin-bound factor. The outcome of chromatin immunoprecipitation and sequencing, which was tweaked by Cut & Run sequencing approach, revealed the promoter region as the preferential genomic location of SMARCB1 and SMARCE1 in mitotic cells  and BAF170 (SMARCC2) as the earliest assembled subunits of SWI/SNF complex5 may benefit expanding the range of SWI/SNF subunits involved in mitotic bookmarking and transmission of the transcriptional memory in cell cycle stages. Knowing the expression dynamics of SWI/SNF subunits driving gene bookmarking in the M-phase of lineage stem cells and cancer cells can lend therapeutic information.For future work, it would be interesting to probe the plausible contribution of SMARCC1 (BAF155) in mitotic bookmarking as it was observed bound to mitotic chromatin, although at a mild intensity.


Misoprostol is a prostaglandin E1 (PGE1) analogue that has been on the World Health Organization (WHO) List of Essential Medicines since 2005.Brazil has one of the most restrictive regulations in the world related to the use of misoprostol establishing it is exclusively for hospital use with special control, and sale, purchase and advertising prohibited by law.Misoprostol is currently the reference drug for pharmacological treatment in cases of induced abortion, both in the first trimester of pregnancy and at more advanced gestational ages.Misoprostol is an effective medication for cervical ripening and labor induction.Misoprostol is an essential drug for the management of postpartum hemorrhage.The use of misoprostol is recommended for the following situations: legal abortion, uterine evacuation due to embryonic or fetal death, cervical ripening before labor induction (uterine cervix maturation), labor induction and management of postpartum hemorrhage.Misoprostol 800 mcg vaginally (four 200 mcg pills) is recommended for uterine evacuation in pregnancy loss up to 13 weeks.In cervical preparation for surgical abortion at less than 13 weeks of pregnancy, the use of misoprostol 400 mcg vaginally 3-4 hours before the procedure is recommended.The use of misoprostol alone according to the gestational age for uterine evacuation is recommended for termination of pregnancy in legal abortion.The use of vaginal misoprostol according to the gestational age is recommended for uterine evacuation in case of fetal death: at 13-26 weeks, 200 mcg every 4-6 hours; at 27-28 weeks, 100 mcg every 4-6 hours; and over 28 weeks, 25 mcg every six hours.The use of misoprostol at an initial dose of 25 mcg vaginally every 4-6 hours is recommended for cervical ripening and induction of labor with a live fetus in pregnancies over 26 weeks.The use of misoprostol for cervical ripening and induction of labor with a live fetus is not recommended in women with a previous cesarean section due to the greater risk of uterine rupture.Misoprostol is a safe and effective option for women with premature rupture of membranes and unfavorable uterine cervix, as long as they do not have contraindications for taking the medication, for example, previous cesarean section.Rectal misoprostol 800 mcg is recommended as part of the drug treatment of postpartum hemorrhage.In Brazil, misoprostol should be made available to all health services at all levels of care, and it is desirable that outpatient use be allowed, when indicated.Misoprostol is a synthetic analogue of prostaglandin E1 (PGE1) with gastric secretion inhibitory and mucosal protection properties through the production of bicarbonate and mucus. It was first approved to be used to protect the stomach mucosa in patients using non-steroidal anti-inflammatory drugs.Misoprostol is a synthetic analogue of PGE1. It is metabolized in the liver, deesterified and becomes the active metabolite, misoprostol acid. It has the ability to bind to uterine smooth muscle cells, increasing the strength and frequency of uterine contractions.Although other prostaglandins can cause myocardial infarction and bronchospasm, misoprostol is not associated with these effects. Toxic doses have not been well established and cumulative doses of up to 2,200 mcg in 12 hours are well tolerated without significant adverse effects.The Food and Drug Administration (FDA) classifies misoprostol as a category X drug  in the first and second trimesters of pregnancy. Animal studies have shown a significant reduction in fertility with the use of high doses (6.25 to 625 times the maximum human therapeutic dose). In pregnant rabbits, doses of 300 to 1,500 mcg/kg of misoprostol on days 7-19 of embryogenesis have been associated with teratogenic effects.Misoprostol is used for uterine evacuation in first trimester pregnancy loss. On ultrasound examination, pregnancy loss can be characterized by the following aspects: presence of gestational sac without yolk sac or embryo and with mean diameter ≥ 25 mm; embryo with crown-rump length greater than or equal to 7 mm without cardiac activity; no embryo with a heartbeat two weeks after an examination demonstrating an empty gestational sac or no embryo with a heartbeat at 11 or more days after an examination demonstrating a gestational sac with yolk sac. In these situations, three approaches are possible: expectant management, mechanical uterine evacuation, or pharmacological evacuation.Brazil has one of the most restrictive regulations related to induced abortion - induced abortion is only legally permitted in cases of pregnancy resulting from rape, risk to the woman's life and fetal anencephaly – and to the use of misoprostol in the world. In a study of countries in Africa, Asia and Latin America, Brazil was close only to Vietnam among those with greater restrictions on access to medical abortion in the world.In cervical preparation prior to surgical abortion in pregnancies over 12-14 weeks, the use of misoprostol 400 mcg  2-3 hours before surgical treatment is routinely recommended.The use of misoprostol on an outpatient basis is considered effective and safe for the treatment of induced abortion, especially in the first 12 weeks of pregnancy. The use of misoprostol during this period has minimal adverse effects, such as diarrhea, vomiting, nausea and fever, which can be easily treated by professionals outside the hospital setting.When the diagnosis of fetal death is established, the health professional assisting this pregnant woman and her family must always be able to answer the posed questions with empathy and embracement, even if there are no answers to all. A systematic review including 14 controlled and randomized studies that evaluated the use of misoprostol in fetal death in the second and third trimesters found 100% effectiveness in uterine evacuation within 48 hours.In cases of fetal death after more than 24 weeks, labor induction depends on the conditions of cervical maturation. In patients with a favorable cervix (Bishop index ≥ 6), labor induction can be started with oxytocin without the use of misoprostol for previous cervical ripening. In patients with an unfavorable cervix and without previous uterine scar, misoprostol is the agent of choice for preparing the cervix and inducing labor.25-26 weeks: misoprostol 400 mcg vaginally or sublingually every 4-6 hours;27-28 weeks: misoprostol 100 mcg vaginally or sublingually every 4-6 hours;Over 28 weeks: misoprostol 25 mcg vaginally every six hours.In patients with previous segmental scarring and unfavorable cervix at 24-28 weeks, cervical preparation can be performed with a mechanical method  followed by the use of oxytocin. The use of misoprostol seems to be an acceptable alternative at this gestational age, since the risk of uterine rupture is low. In a review study in which misoprostol was used at this gestational age, the risk of uterine rupture was 0.28% (95% CI: 0.08-1.00) in patients with a previous cesarean section versus 0.04% (95% CI: 0.01-0.20) in patients without a previous cesarean section.In the labor induction process, when the situation of the uterine cervix is unfavorable, a maturation process is recommended to shorten the duration of induction and increase the chance of vaginal delivery. When the Bishop score is less than 6, the cervix is generally considered unfavorable, and mechanical and/or pharmacological methods can be used in this process.Women planning a vaginal birth after a previous caesarean section  may need labor induction. There are two concerns: reduced chances of vaginal birth after caesarean section (VBAC) and increased risk of uterine rupture. Having a previous vaginal delivery and a favorable cervix are the main predictors of induction resulting in VBAC.No previous vaginal delivery – for example, in a study, the risks of rupture during TOLAC-induced in women without a previous vaginal delivery versus a previous vaginal delivery were 1.5% and 0.6%, respectively;Use of prostaglandins – induction with prostaglandins appears to be associated with a greater risk of uterine rupture than induction with oxytocin or cervical ripening with mechanical methods followed by administration of oxytocin.Risk of rupture with prostaglandin use– Data from large randomized trials and from good quality observational studies on the effects of prostaglandins alone or in combination with other agents for cervical ripening in TOLAC are not available. Much data on prostaglandin use in women with a previous caesarean section has been derived from observational studies in which misoprostol (PGE1) was used. Reports on the use of other prostaglandins, such as prostaglandin E2, are limited by their small size, the co-administration of other agents and the lack of stratification by previous vaginal delivery.Unspecified prostaglandin– Concern over the use of prostaglandins arose following the publication of a large population-based retrospective cohort study that analyzed data from 20,095 primiparous women who delivered after a single previous cesarean section.Repeat cesarean sections without labor: 1.6 ruptures per 1,000 planned repeat cesareans;Spontaneous labor: 5.2 ruptures per 1,000 spontaneous deliveries;Induced labor (without prostaglandins): 7.7 ruptures per 1,000 labors induced without the use of prostaglandins;Induced labor (with prostaglandins): 24.5 ruptures per 1,000 labors induced using prostaglandins. Compared to repeat cesarean delivery, the relative risk of rupture with the use of prostaglandins was 15.6 (95% CI: 8.1-30.0).However, despite the very large number of cases, the information in this study is from a database and individual reviews of medical records were not performed to check other medications administered. The risk of uterine rupture reported in this retrospective study was lower in another large prospective study.American College of Obstetricians and Gynecologists (ACOG –United States)Society of Obstetricians and Gynecologists of Canada (SOGC – Canada)National Institute for Health and Care Excellence (United Kingdom)In conclusion, the use of misoprostol in women with previous cesarean is not recommended given the higher risk of uterine rupture. Note that mechanical methods are available, effective and safe.Premature rupture of membranes (PROM) is one of the most common complications of term and preterm pregnancies, but there is a gap in knowledge about how management affects the cesarean rate. As gestational age at delivery is the critical factor influencing perinatal outcome, expectant management is generally adopted when far from term. In PROM at term, the risk of maternal and fetal infectious morbidity increases with longer duration of membrane rupture. Therefore, expectant management should be brief, with instructions for induction of labor.Postpartum hemorrhage affects around 2% of all patients, and in only 25% of cases the risk factors are pronounced. The obstetrician must perform prophylaxis in 100% of cases and be aware of the occurrence of PPH, even if drug prophylaxis is performed. There is strong evidence that the association of uterotonics prescribed in the immediate postoperative period of childbirth reduces blood loss greater than 500 mL: ergometrine plus oxytocin  and misoprostol plus oxytocin  and reduces the need for blood products .Oxytocin:In post-vaginal delivery: single dose of 10 IU intramuscularly right after birth;In cesarean section: 5 IU in slow intravenous infusion in three minutes and maintenance solution ;Misoprostol: single dose of 600 mcg rectally;Ergometrine: single dose of 0.2 mg intramuscularly.For the drug treatment of PPH, the use of misoprostol 800 mcg rectally is recommended. It is important to remember that since the onset of action of rectal misoprostol is slower than that of other uterotonics, it should be used as an adjuvant to treatment with oxytocin. Misoprostol should not be used in isolation, maintaining uterine massage until the onset of its effect, which may take 15-20 minutes. Always consider the use of tranexamic acid 1 g intravenously over 10 minutes, with the possibility of repeating the 1 g dose in 30 minutes if bleeding persists.Circular letter number 182/2021 of the Office of the President of the Brazilian Federal Council of Medicine,In obstetric practice, misoprostol has been widely used in legal abortion, uterine emptying due to embryonic or fetal death, cervical ripening and labor induction, and management of PPH. Contrary to the accumulated scientific evidence, Brazil has one of the most restrictive regulations in the world related to the use of misoprostol. The great difficulty in acquiring, storing and dispensing the medication imposed by Ordinance No. 344/1998 of Anvisa, still in force, contributes to denying the right to safer outpatient treatments for women who need it. These restrictions also hinder the availability of this medication, essential and mandatory, in obstetric care services.National Commission Specialized in Childbirth, Puerperium and Abortion Care of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo)President:Alberto Trapani JúniorVice-President:Alessandra Cristina MarcolinSecretarySheila Koettker SilveiraMembros:Elias Ferreira de Melo JuniorLiduina de Albuquerque Rocha e SousaMarcia Maria Auxiliadora de AquinoMirela Foresti JiménezRicardo Porto TedescoTenilson Amaral OliveiraNational Commission Specialized in Antenatal Care of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo)President:Fernanda Garanhani de Castro SuritaVice-President:Lílian de Paiva Rodrigues HsuSecretaryAdriana Gomes LuzMembros:Jorge Oliveira VazEliana Martorano AmaralEugenia Glaucy Moura FerreiraFrancisco Herlanio Costa CarvalhoJoeline Maria Cleto CerqueiraJose Meirelles FilhoLuciana Silva dos Anjos FrançaMarianna Facchinetti BrockMary Uchiyama NakamuraPatricia Goncalves TeixeiraRenato AjejeSergio Hecker LuzNational Commission Specialized in Gestational Trophoblastic Disease of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo)President:Antonio Rodrigues Braga NetoVice-President:José Mauro MadiSecretárioMauricio Guilherme Campos ViggianoMembros:Bruno Maurizio GrilloChristiani Bisinoto de SousaClaudio Sergio Medeiros PaivaElaine Azevedo Soares LealElza Maria Hartmann UbertiFabiana Rebelo Pereira CostaIzildinha MaestaJose Arimatea dos Santos JuniorMaria do Carmo Lopes de MeloRita de Cassia Alves Ferreira SilvaSue Yazaki SunTiago Pedromonico ArrymNational Commission Specialized in High Risk Pregnancy of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo)President:Rosiane MattarVice-President:Alberto Carlos Moreno ZaconetaSecretaryMylene Martins LavadoMembros:Arlley Cleverson Belo da SilvaCarlos Alberto MaganhaElton Carlos FerreiraFelipe Favorette CampanharoInessa Beraldo de Andrade BonomiJanete VettorazziMaria Rita de Figueiredo Lemos BortolottoFernanda Santos GrossiRenato Teixeira SouzaSara Toassa Gomes SolhaVera Therezinha Medeiros BorgesNational Commission Specialized in Fetal Medicine of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo)President:Mario Henrique Burlacchini de CarvalhoVice-President:José Antonio de Azevedo MagalhãesSecretaryRoseli Mieko Yamamoto NomuraMembros:Alberto Borges PeixotoCarlos Henrique Mascarenhas SilvaCarolina Leite DrummondEdward Araujo JúniorFernando Artur Carvalho BastosGuilherme Loureiro FernandesJair Roberto da Silva BragaJorge Fonte de Rezende FilhoMarcello Braga ViggianoMaria de Lourdes BrizotNadia Stella Viegas dos ReisReginaldo Antônio de Oliveira Freitas JúniorRodrigo RuanoNational Commission Specialized in Maternal Mortality of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo)President:Marcos Nakamura PereiraVice-President:Rodolfo de Carvalho PacagnellaSecretaryMelania Maria Ramos de AmorimMembros:Acacia Maria Lourenço Francisco NasrDouglas Bernal TiagoElvira Maria Mafaldo SoaresFatima Cristina Cunha PensoIda Perea MonteiroJoão Paulo Dias de SouzaLucila NagataMaria do Carmo LealMonica Almeida NeriMonica Iassanã dos ReisJacinta Pereira MatiasPenha Maria Mendes da RochaNational Commission Specialized in Obstetric Emergencies of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo)President:Alvaro Luiz Lage AlvesVice-President:Gabriel Costa OsananSecretarySamira El Maerrawi Tebecherane HaddadMembros:Adriana Amorim FranciscoAlexandre Massao NozakiBrena Carvalho Pinto de MeloBreno José Acauan FilhoCarla Betina Andreucci PolidoEduardo CordioliFrederico Jose Amedee PeretGilberto NagahamaLaises Braga VieiraLucas Barbosa da SilvaMarcelo Guimarães RodriguesRodrigo Dias NunesRoxana KnobelNational Commission Specialized in Sexual Violence and Pregnancy Interruption Provided for by Law of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo)President:Robinson Dias de MedeirosVice-President:Cristião Fernando RosasSecretaryHelena Borges Martins da Silva ParoMembros:Aline Veras Morais BrilhanteAnibal Eusébio Faúndes LathamDébora Fernandes BrittoEdison Luiz Almeida TizzotIsabelle Cantidio Fernandes DiogenesKenia Zimmerer VieiraMichele Lopes PedrosaOsmar Ribeiro ColasRivaldo Mendes de AlbuquerqueRosires Pereira de AndradeSuely de Souza ResendeZelia Maria CamposNational Commission Specialized in Professional Defense and Appreciation of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo)President:Maria Celeste Osorio WenderMembros:Carlos Henrique Mascarenhas SilvaEtelvino de Souza TrindadeHenrique Zacharias Borges FilhoJuvenal Barreto Borriello de AndradeLia Cruz Vaz da Costa DamásioMaria Rita de Souza MesquitaMirela Foresti JiménezSergio Hofmeister de Almeida Martins CostaCelia Regina da SilvaAljerry Dias do RegoRosires Pereira de AndradeMaria Auxiliadora BudibCarlos Alberto Sa MarquesHilka Flavia Barra do Espirito Santo Alves Pereira


The current systematic review sought to identify quantitative empirical studies that focused on the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination, and their relation with depression and post-traumatic stress disorder (PTSD). The overall research aim was to examine the relationship between these transdiagnostic factors and their relation with depression and PTSD symptoms. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Out of the 768 articles initially identified, 55 met the inclusion criteria for the current review. The results determined that intolerance of uncertainty is indirectly related to depression and PTSD symptoms, mainly through other factors including emotion dysregulation and rumination. Additionally, emotional dysregulation is a significant predictor of both depression and PTSD symptoms. Rumination is a robust factor related to depression and PTSD symptoms, this relationship was significant in cross-sectional and longitudinal studies. This review provides evidence on the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination in the relationship with depression and PTSD symptoms. Depressive, anxiety, and substance use disorders are among the leading contributors to the global disease burden  lack of awareness, understanding, and acceptance of emotions; (b) the inability to control behaviors when experiencing emotional distress; (c) lack of access to situationally appropriate strategies to modulate the duration and/or intensity of emotional responses to meet individual goals and situational demands; and (d) unwillingness or reluctance to experience emotional distress as part of seeking meaningful activities in life  guidelines  Empirical quantitative research reports published in a peer reviewed journal (2) Written in English or Spanish language, (3) Outcome measures related to depression or PTSD symptoms or diagnosis. Studies were excluded if the following criteria was met: (1) No depression or PTSD outcome measure, (2) No rumination, intolerance of uncertainty or emotional dysregulation measure, (3) Not depression PTSD comorbidity, (4) Children or adolescent sample, (5) Insufficient or inappropriate data reported , specifically USA (21 studies), and Canada (3 studies). Followed by 25.5% from European countries, 16.4% from Asia including China (4 studies), Japan (1 study), India and Iran (2 studies each), 7.2% from Oceania particularly, Australia (4 studies), and 7.2% from South America including Argentina (2 studies), Colombia and Chile (1 study each). Community-based studies were the most frequent type (39%), followed by undergraduate student sample (27.1%), clinical sample (18.6%), and trauma exposed sample (15.3%). Most of the studies were cross-sectional (66.1%), followed by longitudinal (28.6%) and a minority were experimental (5.4%).Eleven studies examined the relation between intolerance of uncertainty and depression symptomatology. Empirical evidence indicates that intolerance of uncertainty is a significant predictor of depression symptoms, even when anxiety symptoms where accounted for (Barry et al., Six studies that examined the relation between intolerance of uncertainty and PTSD symptoms. This evidence indicates that intolerance of uncertainty is a significant predictor of PTSD symptoms. These result remained significant even after covarying for other PTSD risk factors including: rumination, neuroticism, and worry (Boelen et al., When the relation between intolerance of uncertainty and PTSD symptoms DSM-V clusters was examined, there was a significant association to the avoidance, hyperarousal and emotional numbing symptom clusters (Oglesby et al., We identified 8 studies that assessed the relation between emotion dysregulation and depression symptoms. Results indicated that emotion dysregulation was positively associated with depressive symptoms, even when controlling for baseline mindfulness (Diehl et al., Seven studies assessed the relation between emotional dysregulation and PTSD symptoms. Longitudinal assessments found that emotional dysregulation was significantly associated with the probability of developing PTSD symptoms 4 months later (Fujisato et al., Thirteen studies examined the relation between rumination and depression symptoms. Results from longitudinal associations indicated that rumination predicts depressive symptoms and that depressive symptoms predict rumination at 4-year follow-up (Whisman et al., Ten studies examined the relation between rumination and PTSD. Repetitive and anticipatory rumination moderated the relationship between PTSD and MDD symptoms (Roley et al., The current systematic review sought to identify quantitative empirical studies that focused on the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination, and their relation with depression and/or PTSD. This review identified 55 studies that reported the association between the transdiagnostic factors of interest in depression and PTSD symptoms.Intolerance of uncertainty was a consistent significant predictor for both depression and PTSD symptoms, as suggested by other authors (McEvoy et al., Emotional dysregulation has been found to relate to depression as well as many other psychiatric symptoms including PTSD (Aldao et al., Rumination is an important factor related to the maintenance and exacerbation of depression and PTSD symptoms (Olatunji et al., This systematic review had a number of limitations that should be taken into account when interpreting the results and addressed in future research. First, even though studies in Spanish were included in an attempt broaden the scope, the majority of the studies were conducted in North American and European countries. Furthermore, taking into consideration the evidence that culture may play a significant role in the manifestation of psychopathology Rathod, , the resThis review provides evidence that the transdiagnostic factors of intolerance of uncertainty, emotional dysregulation and rumination are consistent significant predictors for both depression and PTSD symptoms. Particularly, intolerance of uncertainty is indirectly related to depression and PTSD symptoms through other factors including emotion dysregulation and rumination. Meanwhile, emotional dysregulation is a significant predictor of both depression and PTSD symptoms. Rumination is a robust factor related to depression and PTSD symptoms, this relationship was significant in cross-sectional and longitudinal studies. Both emotional dysregulation and rumination can mediate the relationship between several risk factors including intolerance of uncertainty and depression and PTSD symptoms. This study provides insight into understanding these factors in the onset and maintenance of depression and PTSD symptomatology. Consequently, contributing to the evidence that allows the development of theoretical and empirically supported transdiagnostic models. Which may ultimately promote the development of cost-effective treatments that targets underlaying mechanism or factors, thus promoting preventative alternatives for multiple disorders.


Motivation is an important factor in therapy and potentially even more so in an online setting. Earlier research shows that more autonomously motivated patients have better outcomes and completion rates than more controlled motivated patients´. However, little is known about how motivation type influences treatment effect in an online setting and in patients with binge eating disorder specifically.This study set out to investigate how motivation type as per the Self-Determination Theory would affect treatment adherence and effect in a sample of 148 patients, undergoing an Internet-based Cognitive Behavioral Therapy (iCBT) for BED.The study was mixed-methods. A sample of 148 patients gave two written qualitative statements regarding their motivation for seeking treatment and reasons for choosing online therapyThe statements were transformed into quantitative units via the condensation method. The themes were categorized according to the model by Ryan and Deci based on level of autonomy and perceived locus of causality.This was compared with completion rate and outcomes on eating disorder symptomatology. Completion was designated into three groups. Low adherers - less than six sessions (n=54), high adherers – between 7 and 10 sessions (n =56) and full adherers - 10 session plus follow up (n=37).The effect of the treatment was measured via the Eating Disorder Examination Questionnaire (EDEQ) and Binge Eating Disorder Questionnaire (BEDQ).Perceived locus of causality and level of autonomy, did not affect level of adherence or outcome of treatment in either setting. This unexpected result may suggest that internet-based therapy is less dependent on motivation types, when comparing with face-to-face treatment.None Declared


Correction to: Japanese Journal of Radiology (2021) 39:84–92 10.1007/s11604-020-01040-1In the original publication, the last sentence under heading Patients in section Materials and methods should read as:All patients gave written informed consent for the procedure.The revised Ethical approval statement should read as:Ethical approval All procedures performed in these studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments. All patients gave written informed consent for the procedure. The institutional review board of our hospital approved retrospective data analysis.


After this article was published, similarities were noted between this article  and submIn response to queries about these concerns, the corresponding author provided the underlying data in During editorial follow-up, the following errors in article  were notThere are two instances in The Nakano study  involvedThe Lehmann study  T stage The Matrana study  T stage In Table 1:The univariate analyses  instead of the multivariate analyses  from Kubackova’s research [An expert statistical reviewer assessed the updated PLOS ONE Editors issue this Expression of Concern.The concerns about specific results were resolved in discussions with the authors and reviewer, and the dataset received from the authors provides a level of assurance as to the provenance of this work. Nevertheless, PLOS remains concerned about similarities between  and otheS1 File(XLSX)Click here for additional data file.S2 File(XLSX)Click here for additional data file.S3 File(CSV)Click here for additional data file.


There is a large gap between the need for anticoagulation and the use of drug therapy for this purpose in ambulatory care. Major lower-extremity orthopedic surgery such as total hip replacement and total knee replacement are associated with an increased risk of venous thromboembolism (VTE). Anticoagulant prophylaxis is necessary to reduce the risk of deep vein thrombosis (DVT), which may progress to symptomatic outcomes such as pulmonary embolism (PE). Prophylaxis and treatment of patients with symptomatic VTE occurs in 2 phases. Initial therapy focuses on rapid achievement of effective anticoagulation and usually involves subcutaneous low-molecular-weight heparin. Long-term prophylaxis with the vitamin K antagonist, warfarin, reduces the risk of recurrent VTE from about 27% (without prophylaxis or inadequate prophylaxis) to 4% during the first 3 months of observation.


Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice.


Sussex cattle breed is characterized by their distinctive solid red coat colour and white tail switch. Sussex cattle are known for being easy to handle and manage, making them an ideal choice for cattle farmers. The phenotypic characterization of this cattle breed in South Africa is unknown. Hence, the objective of this study was to characterize the morphological structure, phenotypic and body indices traits of Sussex cattle in South Africa at Huntersvlei farm, Frere State province of South Africa. One hundred and one weaners (n = 101) between 6 and 8 months old  and fifty yearlings between 12 and 15 months old  were used in this study. Body weight at weaning, yearling and linear body measurements such as head length (HL), head width (HW), ear length (EL), ear width (EW), sternum height (SH), withers height (WH), heart girth (HG), hip height (HH), body length (BL), rump length (RL), and rump width (RW) were measured. Moreover, the animals were assessed for coat colour and horn presence. Descriptive statistics, Pearson’s correlation and Principal Component Analysis (PCA) were used to describe the Sussex cattle breed. The results indicated that male Sussex cattle had highly significant (p < 0.01) mean numeric values for the BW and morphometric traits. The results further showed that Sussex cattle had highly significant (p < 0.01) increase for the BW and morphometric traits as age advances in all sexes. Interaction effect of sex and age showed a highly significant (p < 0.01) effect with BW and measured morphometric traits, while moderately significant (p < 0.05) with EW. Male Sussex cattle showed highly significant (p < 0.01) higher mean numeric values for the body index (BI), length index (LI) and compact index (CI) indices. While female Sussex animals showed highly significant (p < 0.01) mean numeric values for area index (AI) and proportionality (PR). Body weight showed a positive highly significant (p < 0.01) correlation with the measured morphometric traits except for the moderate significant (p < 0.05) correlation with EL. Coat colour traits ranged from 15 (9.93%), 103 (68.21%) to 33 (21.85%) for light, moderate and dark colours, respectively. While horn presence traits ranged from 48 (31.79%), 42 (27.81%) to 61 (40.40%) for polled, scur and horned respectively. The PCA results extracted only two components in both sexes of the animals. The morphological variations obtained in this study could be complemented by performance data and molecular markers of single nucleotide polymorphism (SNP) to guide the overall breed characterization, conservation and development of appropriate breeding and selection strategies. Livestock plays an important role in the social, economic and cultural stability of rural households in many parts of the world . MASA 22 reporteThe experimental procedures were conducted following the University of South Africa (UNISA) Ethics code for the use of live animals in research, ethics reference number: 2022/CAES_AREC/171.This study was conducted at Huntersvlei farm also known as Rhys Evans Group (RE) in the Free State Province, South Africa. The farm is situated in Viljoenskroon, Fezile Dabi municipality; the site, temperatures, latitudes, longitude, and rainfall of the study area similar as described by Bila . HuntersAll the animals used in the study were exposed to a traditional management grazing system which allows animals to freely graze in the camps during the day and afternoon. Fresh clean water was always available in the camps. Animals received a routine inspection and dipping for herd health management purposes. The linear body measurements were taken while the animal was in a standing position with head raised up and weighed on all four feet. A functional handling facility with a crowding pen, working crush and head clamp was used for handling the animals to minimize movement during the measuring process.Morphometric traits and live body weight at two different stages were taken. The first stage was at weaning age in one hundred and one (n = 101)  South African Sussex weaner animals between 6 and 8 months old. Second stage yearling age is 50  South African Sussex yearling animals are between 12 and 15 months old. The animals used in the study at weaning age were between six to fifteen months old. The live body weight at the two stages was measured using a balance weighing scale whereas linear body measurements were measured using a measuring tape calibrated in centimetres (cm). The body weight at weaning, yearling and morphometric traits, namely head length (HL), head width (HW), ear length (EL), ear width (EW), sternum height (SH), withers height (WH), heart girth (HG), hip height (HH), body length (BL), rump length (RL), and rump width (RW) were measured following the guideline defined by Lomillos and Alonso , Tyasi eTo prevent individual variations in measurements, only one individual was taking the body weight and morphometric traits. The horn presence was assessed using three point scale  following the guidelines reported by Grobler et al. . Moreove2) test was used to find the significant difference on qualitative traits. Procedure of correlation (PROC CORR) was used to determine Pearson’s correlation matrix. These analyses were then followed by a principal component analysis (PCA) to reduce the dimensionality of the morphometric data using the procedure of principal component (PROC PRINCOMP and PROC FACTOR). Furthermore, to examine the morphometric traits and body indices that have the most discriminating power the stepwise discriminant analysis was applied using the STEPDISC procedure (PROC STEPDISC). The significant difference was observed at P<0.05 and highly significant at P<0.01.The Statistical Analysis System  version The overall summary of the collected data  discoverMeans and standard deviation for the sex effect on body weight and morphometric traits is given in The overall summary of the collected data  discoverMeans and standard deviation for the overall sex effect on body indices is given in In females, the BI showed a positive highly significant (p < 0.01) correlation with LI, while moderately significant (p < 0.05) correlated with PI and insignificant (p > 0.05) correlated with CI . PI showThe overall summary of the collected data  discoverThe frequency and percentage of coat colour and horn presence observed in males and females of Sussex cattle at Huntersvlei farm population are presented in The frequency and percentage of coat colour and horn presence observed in males and females of Sussex cattle at Huntersvlei farm populations are presented in The predicted factor loading extracted by factor analysis, eigen-values and variation explained by each factor are presented in The CDA for morphometric traits of South African Sussex cattle are presented in The CDA for body indices traits of South African Sussex cattle are presented in This study was exclusively based on specific phenotypic and morphometric traits of Sussex cattle at Huntersvlei farm in the Free State, Province, South Africa. Phenotypic variation of local animal resources shows a genetic diversity that may be worth conserving for future uses while better understanding of the external features assists to facilitate the implementation of conservation policies intended to ensure local resources survival . FirstlyFurthermore, the results of the study showed that the coat colour both in male and female populations had a highly significant effect with males showing a maximum incident of dark coat colour while females showing a maximum incident moderate coat colour. On the other hand, the horn presence showed a significant effect amongst the sexes with males showing a maximum occurrence of horn presence and females showing a maximum occurrence of polledness. Bila and Tyasi  showed tThe importance of morphological characterization of cattle breed’s genetic resources cannot be emphasized. The present study is based on morphometric and certain phenotypic traits of Sussex cattle at Huntersvlei farm in South Africa. The study findings displayed the morphological and phenotypic variations between ages and genders of the Sussex cattle breed at Huntersvlei farm. It was found that the Sussex cattle breed in the study area have developed some diverse phenotypic traits such polled, scur and horns. Moreover, the Sussex cattle at Huntersvlei farm showed that the male animals had a much darker red brown colour in comparison to female animals. The correlation results shown that in male BW had highest positive association with HH, BL and WH and hence can be used as markers to predict BW using regression equations. The extracted principal components from different morphometric traits symbolize the general body size and shape of the Sussex cattle population at Huntersvlei farm. Stepwise canonical discriminant analysis showed that head width, head length, hip height, sternum height, heart girth and rump width are the suitable discriminating morphometric traits in the Sussex cattle breed. Furthermore, an investigation on the molecular characterization using molecular markers SNP will complement the results obtained from morphometric variation. Lastly these findings might be helpful in breed characterization, conservation and developing breeding and selection strategies.S1 FileIt is an Excel file with variables fully explained in column P and Q of the sheet.(XLSX)Click here for additional data file.S2 FileIt is an Excel file with variables fully explained in column E, F and G of the sheet.(XLSX)Click here for additional data file.


Based on studies showing the use of autologous skin cell suspensions (ASCS) leads to burn wound closure with significantly smaller amounts of harvested donor skin, the Food and Drug Administration approved the first ASCS for the reconstruction of thermal injuries in September, 2018. The benefit of needing less donor skin to heal a given soft tissue wound has led to off-label usage of ASCS in a variety of clinical situations, such as necrotizing soft tissue infections (NSTI), toxic epidermal necrolysis (TEN), and traumatic injuries with soft tissue loss among others. Here, we report on a single-institution case series of ASCS usage for closure of soft tissue wounds caused by nonthermal mechanisms.We performed a retrospective chart review of all patients treated with ASCS for an indication of non-thermal soft tissue wounds at our American Burn Association-verified academic burn center between April 1, 2018 to June 1, 2022. Descriptive demographic data were collected.+ 17 yrs, mean length of stay 46 + 30 days) were found to have undergone closure of their wounds using ASCS during the time period of the chart review. Indications were NSTI (n=2), frostbite (n=2), antiphospholipid syndrome (n=2), and TEN (n=2). ASCS was used as a sole therapy for the TEN patients while ASCS was used in combination with meshed autografting for all other patients. The mean size of wounds treated with ASCS was 2835 + 2670 cm2, and the mean ASCS take rate was 86 + 7%. No ASCS-related complications were found.Eight patients (6 male/2 female, mean age 57 These results bolster the off-label use of ASCS solutions for closure of nonthermal wounds while the surgical world awaits the results of an ongoing Phase III trial on this questionThis study seeks to contribute to the literature supporting off-label uses of ASCS in non-thermal injuries & diseases.