Fabrication strategies towards hydrogels for biomedical application: chemical and mechanical insights

This review aims at giving selected chemical and mechanical insights on design criteria that should be taken into account in hydrogel production for biomedical applications. Particular emphasis will be given to the chemical aspects involved in hydrogel design: macromer chemical composition, cross-linking strategies and chemistry towards “conventional” and smart/stimuliresponsive hydrogels. Mechanical properties of hydrogels in view of regenerative medicine applications will also be considered

A Project Module of E-Commerce Planning

The development of a pedagogy that integrates scholastic knowledge and practical skills of e-commerce for business students is imperative. Students typically learn e-commerce planning through course projects. This note provides tips for designing and teaching an e-commerce planning project module for the e-commerce course

Silk Sericin-Based Electrospun Nanofibers Forming Films for Cosmetic Applications: Preparation, Characterization, and Efficacy Evaluation

This study investigates the extraction, characterization, and cosmetic application of silk sericin, a protein derived from Bombyx mori silkworm cocoons, with a focus on its potential in sustainable and biodegradable cosmetic formulations. Sericin was extracted using a high-temperature, high-pressure autoclave degumming method and spray-dried into a stable powder. The molecular weight distribution of sericin was analyzed, revealing fractions ranging from 10 to 37 kDa in Elution 1A and 25–40 kDa in Elution 1B. Electrospinning of sericin led to increased β-sheet content compared to raw sericin, as shown by secondary structure analyses. The electrospun sericin was then blended with gelatin to enhance mechanical strength and stability, resulting in robust films suitable for cosmetic applications. These films were developed into eye contour patches designed to deliver moisturizing, elasticizing, and smoothing effects. The efficacy of the patches was evaluated in 20 participants, showing increased skin elasticity (+35.1%) and smoothness (Ra: −30.7%, Rz: −26.6%), though a decline in hydration was observed, potentially indicating opportunities for further optimization

240 - What is the best treatment for urinary incontinence in older women? A Cochrane network meta-analysis

Hypothesis / aims of studyUrinary incontinence (UI) is highly prevalent among women 60 years and over, impairing their quality of life and leading to various health complications (1). The condition is often overlooked and untreated due to misconceptions about aging (2). Globally, UI poses a significant social, economic, and health burden, especially considering the increasing older adult population (3). The aim of this study was to determine the efficacy and safety of conservative, pharmacological, and surgical treatments for the safety, cure and cure and improvement of UI in women 60 years and over using network meta-analysis (NMA), and to rank the numerous interventions within one treatment network. This approach addresses how menopause and ageing, along with associated comorbidities, affect treatment efficacy and safety, ultimately guiding optimal care for older women with UI.Study design, materials and methodsWe searched the Cochrane Incontinence Specialized Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP, and hand searching of journals and conference proceedings (searched 13 July 2023), and reference lists of relevant articles. We included all randomized controlled trials (RCTs) which evaluated the effectiveness of different treatments (conservative, pharmacological and surgery) for the treatment of stress, urgency, mixed or unclassified types of UI according to symptoms, signs and/or urodynamic evaluation, as defined by the trial investigators in older women (i.e., women 60 years and over). We included studies involving participants with symptoms of overactive bladder, pelvic organ prolapse and had undergone previous treatments for UI only if UI was present. At least two reviewers independently screened titles and abstracts, followed by the full-text for all relevant articles. At least two review authors independently performed data extraction, risk of bias assessment (RoB) using the RoB 2 tool and evidence certainty assessment using the ‘Confidence in Network Meta-Analysis’ CINeMA approach.ResultsAfter exclusions, 43 RCTs involving 8,506 participants with a mean of 198 participants per study (range 14 to 1438) remained. There were 20 different active treatment nodes, administered either alone or in combination. The treatment nodes predominantly comprised pharmacological treatment, followed by surgical treatments, with a relatively small number of conservative treatment nodes. Most trials (28/43, 65%) compared treatment against placebo/no treatment. The majority of the studies included conservative treatments (20/43, 46.5%), followed by pharmacological (17/43, 39.5%), surgical treatments (4/43, 9.3%) and mixed types of treatments (2/43, 4.7%). The trials presented variable RoB, often presenting \u27some concerns\u27 or \u27high risk,\u27 with poor reporting on randomization, blinding, and protocol details. Conservative or pharmacological treatments showed high RoB for most outcomes.CureCure of UI was measured in 18 studies. Many of the studies included in the analysis used participants\u27 subjective measures, such as self-reported absence of leakage recorded in urinary diaries, participants\u27 perception of cure as assessed through interviews or questionnaires, or cure derived from adapted questionnaires. Other methods used to assess cure included reports of wet episodes checked by the research staff and objective measures such as cough tests and pad tests. For cure, the network was adjusted by excluding certain studies to address disconnections, leading to a comparison primarily among physical therapies (with or without additional treatments), antimuscarinic drugs, and controls.Results (Table 1 and Figure 1) indicated that all treatments might be better than control, with physical therapies - mainly pelvic floor muscle training with or without complementary therapies, showing the best performance for curing UI (physical therapies + complementary therapies: OR 22.94, 95% CI 1.26 to 418.19, low certainty evidence; physical therapies: OR 8.94, 95% CI 1.97 to 40.51, very low certainty evidence; complementary therapies: OR 6.00, 95% CI 0.32 to 113.4, very low certainty evidence). Across the three treatments that included physical therapies the likelihood of being ranked first or in one of the top ranks was higher than for the other treatments (SUCRA values ranging from 56.5% to 84.9%) but the certainty of the evidence was low to very low.Cure or improvementCure or improvement of UI symptoms was measured in 17 studies. The reported measures included subjective assessments using questionnaires and/or questionnaire-related inquiries regarding participant perceptions of cure and improvement as well as the reduction in the number of daily recorded urinary episodes. One study reported improvement based on the reports of wet episodes checked by the research staff. Results in Table 1 and Figure 1 show that physical therapies, with or without education, performed best compared to controls (physical therapies: OR 3.98, 95% CI 2.02 to 7.82, very low certainty evidence; physical therapies + education: OR 3.20, 95% CI 1.45 to 7.02, very low certainty evidence; β3-adrenergic agonists: OR 2.44, 95% CI 1.28 to 4.62, very low certainty evidence). Physical therapies with or without addition of an educational treatment were the best performing treatments (when compared to control) (physical therapies: SUCRA = 89.9%; physical therapies + education: SUCRA = 77.3%).SafetyOf the included studies, 16 provided information on serious adverse events (SAEs) (i.e., occurrence or absence). There was considerable heterogeneity in data with variation across reports, including differences in the selection, specification, and classification of SAEs, as well as in the method of measurement (e.g., reporting the number of events versus the number of participants experiencing SAEs).Results in Table 1 and Figure 1 showed relatively few reported SAEs across trials and there was no treatment that was superior in terms of having significantly less chance of SAEs (serotonin-noradrenaline uptake inhibitors: OR 0.4, 95% CI 0.1 to 1.59; β3-adrenergic agonists: OR 0.61, 95% CI 0.04 to 10.19; complementary therapies: OR 0.53, 95% CI 0.00 to 71.05).Surgical therapies were not assessed in the NMA due to gaps in the data.Interpretation of resultsThis review compared treatments for women 60 years and over, using a NMA to rank treatments based on cure, cure or improvement of UI symptoms, and SAEs. Including 43 studies with 8,506 participants, it focused on conservative, pharmacological, and surgical treatments. Physical therapies, especially when combined with complementary therapies or education, were the most likely to be in the highest rank or ranks for cure, and cure or improvement of UI symptoms however with low to very-low certainty of evidence. There was a lack of uniformity and consistency in how SAEs were reported making our results difficult to interpret. Only studies focusing on pharmacological treatments reported SAEs, with the number of events ranging from none to low. In contrast, studies focusing on conservative treatments reported no SAEs.Concluding messageThis review suggests that physical therapies, with or without educational or complementary therapies, show promise for treating UI in older women, though the certainty of the evidence is low to very low. The limited number of small studies contributes to uncertainty about treatment efficacy. There is a need for more studies on conservative, pharmacological and surgical treatments with standardized outcomes and clear reporting of interventions and adverse events to improve UI management in aging women.Funding This work was supported by the Centre de recherche de l’Institut universitaire de g\ue9riatrie de Montr\ue9al and Fonds de recherche du Qu\ue9bec – Sant\ue9 (FRQS). CD received a salary award from the Canadian Research Chair Tier II program (2021-2022) Clinical Trial No Subjects Human Ethics not Req\u27d Systematic review and network meta-analysis Helsinki not Req\u27d Systematic review and network meta-analysis Informed Consent N

Asthma incidence can be influenced by climate change in Italy: findings from the GEIRD study—a climatological and epidemiological assessment

An association between climatic conditions and asthma incidence has been widely assumed. However, it is unclear whether climatic variations have a fingerprint on asthma dynamics over long time intervals. The aim of this study is to detect a possible correlation of the Summer North Atlantic Oscillation (S-NAO) index and the self-calibrated palmer drought severity index (scPDSI) with asthma incidence over the period from 1957 to 2006 in Italy. To this aim, an analysis of non-stationary and non-linear signals was performed on the time series of the Italian databases on respiratory health (ISAYA and GEIRD) including 36,255 individuals overall, S-NAO, and scPDSI indices to search for characteristic periodicities. The ISAYA (Italian Study on Asthma in Young Adults) and GEIRD (Gene Environment Interactions in Respiratory Diseases) studies collected information on respiratory health in general population samples, born between 1925 and 1989 and aged 20-84 years at the time of the interview, from 13 Italian centres. We found that annual asthma total incidence shared the same periodicity throughout the 1957-2006 time interval. Asthma incidence turned out to be correlated with the dynamics of the scPDSI, modulated by the S-NAO, sharing the same averaged 6 year-periodicity. Since climate patterns appear to influence asthma incidence, future studies aimed at elucidating the complex relationships between climate and asthma incidence are warranted

239 - What is the most effective pelvic floor muscle training type, dose, and delivery method for females with urinary incontinence? A Cochrane review with meta-analysis

Hypothesis / aims of studyWe updated the 2011 Cochrane review comparing different approaches to pelvic floor muscle training (PFMT) [1] to treat female urinary incontinence (UI) for two reasons. First, to address ongoing uncertainties as a scoping search suggested many more potentially eligible randomised controlled trials (RCTs) were published. Second, neither the previous review nor the most up-to-date alternative [2] applied ‘Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) to gauge evidence certainty to underpin clinical decision-making. Therefore, we aimed to complete a systematic review and meta-analysis, using contemporary Cochrane methods, of RCTs comparing different approaches to PFMT to increase the power, accuracy, and certainty in effect estimates. We investigated differences in exercise type, dose, and intervention delivery.Study design, materials and methodsSystematic review methods were according to the Cochrane Handbook for Systematic Reviews of Interventions (version 6.4). The previous review was, as per Cochrane practice, the published protocol for the update [1].Eligible trials were RCTs (excluding cross-over RCTs) in females with UI. Trials with pregnant or postpartum participants or those with neurological conditions were excluded. To investigate different pelvic floor muscle (PFM) exercise types, eligible RCTs compared coordinated (voluntary PFM contraction with other body movement, e.g. squats), or functional (voluntary PFM contraction within activities of daily living, e.g. the Knack), or indirect (exercise to improve PFM function without voluntary PFM contraction) or combined (indirect with direct) training versus direct PFMT (repeated, isolated, voluntary PFM contractions). To investigate exercise dose, eligible trials had the same exercise type and delivery method in both trial arms but with differences in exercise dose (e.g. more versus fewer training sessions per week). For exercise intervention delivery eligible trials compared different methods of delivery/supervision (e.g. more versus less in-person clinic supervision).The Cochrane Incontinence Specialised Registry was searched on 27 September 2023, with no date or language limits. The register comprises studies identified from: the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL and handsearching. Study records were screened in Covidence. Each review stage was completed by two independent reviewers with any disagreements resolved through discussion: title and abstract screening, full text screening, data extraction onto a template revised from the previous review to include Consensus on Exercise Reporting Template PFMT (CERT-PFMT) items [3], and risk of bias (RoB) assessment using Cochrane ROB tool v1. All records were re-screened and evaluated regardless of inclusion or exclusion from the previous review. Two reviewers (JHS, MSP) cross-checked all RoB assessments, and completed the GRADE certainty of evidence ratings. Decision-rules were documented to ensure consistency.The primary outcome was incontinence or lower urinary tract symptom specific quality of life (QoL) at the primary endpoint (as defined by trialists), measured using any instrument rated A or A+ by the 7th ICI based on psychometric properties [2]. We contacted study authors if data were collected but missing, incomplete, or reported in unusable format. The secondary outcomes (incontinence episode frequency, incontinence symptom severity, patient-reported improvement, patient-reported satisfaction, and adverse events) are not reported here.A standardised mean difference (SMD) with inverse variance weighted method was used in RevMan Web 2023 for meta-analysis. Thresholds suggested by Cohen (1988) were used for interpretation: a small (> 0.2 to <0.5), moderate (> 0.5 to < 0.8), and large (> 0.8) effect. Effect sizes under 0.2 were considered unimportant even if statistically significant.Data were pooled in subgroups only; subgroups organised data by intervention and comparator. If within subgroup heterogeneity was substantial (I2 > 50%) we conducted a sensitivity analysis (low versus higher risk of selection bias, and attrition bias). If the between subgroup heterogeneity was substantial, we narratively summarised plausible explanations.ResultsAfter removing duplicates, we screened 2385 records and excluded 2172 based on title/abstract. From 213 full texts retrieved, 87 were excluded, most commonly for an ineligible comparison. The remaining full texts represented 126 trials (some with more than one full text): 64 included trials, 40 eligible ongoing trials, and 22 trials awaiting classification (i.e. missing information precludes eligibility decision). Trials included 4972 participants: previous review included 21 trials, 1490 participants [1].Sixty-one RCTs were parallel designs, and three were cluster RCTs. Sample sizes ranged from 11 to 362. Nine trials recruited > 50 participants per trial arm. The nine larger trials contained 42% of participants (2090/4972) but three of them reported no outcome of interest or usable data.No trial was conducted in a low-income country. Seven were completed in lower-middle income countries but 3 reported no outcome of interest or usable data.Overall RoB rating considered selection, attrition, reporting and other bias with five at low risk overall, six at high risk, and the remainder at unclear risk. Regarding selection and attrition bias, on which sensitivity analysis was based, there were 19 low and six high risk, and 22 low and 27 high risk trials respectively. Risk of bias rating did not consider blinding because all outcomes of interest in the review were patient-reported.UI diagnoses were stress UI (n=36), stress predominant mixed UI (n=10), stress or mixed UI (n=6), stress, urgency, or mixed UI (n=7), and undefined “urinary incontinence” (n=4). Trial participants were typically aged from 45 to 65 years and parous, with no prior incontinence treatment or pelvic surgeries, or other appreciable pelvic floor dysfunction.Trials compared exercise type (27 trials; 3 subgroups), dose (11 trials, 4 subgroups) and intervention delivery (26 trials; 5 subgroups with data, and one without any usable data). Correct voluntary PFM contraction was confirmed for all women (35 trials), in one trial arm (five trials), or not mentioned.In addition to reporting only QoL here, we do not report findings from subgroups containing a single, small trial; in those instances, the number of downgrades of evidence quality precluded a certainty of evidence statement.Summary of findings is presented in Table 1.Interpretation of resultsThe number of trials, and participants, has trebled. Progress is being made toward addressing the highest priority uncertainty in incontinence research—what is the optimal PFMT protocol—identified by Buckley and colleagues using a James Lind Alliance approach in 2010. However, the specific uncertainties they mentioned—training frequency and duration, and the optimal training for different patterns of UI—remain. Too few trials investigate exercise dose or recruit females with diagnoses other than stress or stress predominant UI.There is now some moderate certainty evidence to support clinical decisions about PFMT and its delivery in mid-age and older women. There is probably not support for indirect training approaches, alone or in combination with direct PFMT. Adding a resistance device to PFMT probably adds no benefit. There is probably no important difference in incontinence QoL outcome between individual and group supervision of PFMT; a correct contraction was confirmed prior to group supervision in 3 of 6 trials (209/280 women, 75%). Using e-health for delivery of PFMT is probably better than written instructions only.To increase evidence certainty for clinical decision-making, in addition to the usual improvements in trial size, methods and reporting, we need to address important uncertainties such as those identified by Buckley and colleagues.Concluding messageOf the many methods of training that appear to be used in practice, direct PFMT is probably the intervention of choice. In-person supervision can probably be offered individually or in groups after confirmation of a correct PFM contraction. If supervision is not-in-person then e-health is probably better than written instruction.Funding None Clinical Trial No Subjects Non

Gastritis and gastroesophageal reflux disease are strongly associated with non-allergic nasal disorders

Background: Gastroesophageal reflux disease (GERD) has been reported to be significantly associated with chronic rhinosinusitis, but the strength of the association is still debated. Aims: To evaluate the strength of the association between gastritis/GERD and non-allergic rhinitis (NAR)/allergic rhinitis (AR)/sinusitis. Methods: We investigated 2887 subjects aged 20–84 years, who underwent a clinical visit in seven Italian centres (Ancona, Palermo, Pavia, Terni, Sassari, Torino, Verona) within the study on Gene Environment Interactions in Respiratory Diseases, a population-based multicase-control study between 2008 and 2014. Subjects were asked if they had doctor-diagnosed “gastritis or stomach ulcer (confirmed by gastroscopy)” or “gastroesophageal reflux disease, hiatal hernia or esophagitis”. The association between NAR/AR/sinusitis and either gastritis or GERD was evaluated through relative risk ratios (RRR) by multinomial logistic regression. Results: The prevalence of gastritis/GERD increased from subjects without nasal disturbances (22.8% = 323/1414) to subjects with AR (25.8% = 152/590) and further to subjects with NAR (36.7% = 69/188) or sinusitis (39.9% = 276/691). When adjusting for centre, sex, age, education level, BMI, smoking habits and alcohol intake, the combination of gastritis and GERD was associated with a four-fold increase in the risk of NAR (RRR = 3.80, 95% CI 2.56–5.62) and sinusitis (RRR = 3.70, 2.62–5.23) with respect to controls, and with a much smaller increase in the risk of AR (RRR = 1.79, 1.37–2.35). Conclusion: The study confirmed the association between gastritis/GERD and nasal disturbances, which is stronger for NAR and sinusitis than for AR

JPN Guidelines for the management of acute pancreatitis: severity assessment of acute pancreatitis

This article addresses the criteria for severity assessment and the severity scoring system of the Ministry of Health and Welfare of Japan; now the Japanese Ministry of Health, Labour, and Welfare (the JPN score). It also presents data comparing the JPN score with the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Ranson score, which are the major measuring scales used in the United States and Europe. The goal of investigating these scoring systems is the achievement of earlier diagnosis and more appropriate and successful treatment of severe or moderate acute pancreatitis, which has a high mortality rate. This article makes the following recommendations in terms of assessing the severity of acute pancreatitis