is the main driver of intolerance. Intolerant patients have higher patient-reported outcomes. Qualitative studies are needed to explore causes and potential solutions to MTX intolerance.

The factors associated with low back pain (LBP) and the relationship between LBP and ball velocity during kicking motion of adolescent soccer players remain largely unknown. This study aims to clarify the relationship between increasing ball velocity and LBP in adolescent soccer players.

Adolescent soccer players were divided into two groups according to the presence and absence of LBP (LBP group, n=38 and NBP (no back pain) group, n=29, respectively). Real-time kick motion was measured using a three-dimensional motion analysis system and the angle of the lumbar spine, hip, and center of mass (COM) were calculated. Regression analysis was used to identify factors associated with ball velocity and LBP. In addition, Pearson’s correlation coefficients were determined between the angle of the lumbar spine and hip, and ball velocity and position of COM in the extracted phase from regression analysis.

The major factor associated with increasing ball velocity was the rotation angle of both hips (Adjusted R

=0.244) and vertical position of COM during kicking (Adjusted R

=0.262). Furthermore, the factors associated with LBP were the flexion angle of kick-side hip (OR=1.126) and abduction angle of both hips (kick-side OR=1.124; support-side OR=0.872). The factors for ball velocity and LBP were related to the maximum hip extension phase. In the hip extension phase of kicking, compared with the NBP group, the LBP group showed lesser extension and external rotation of the kick-side hip angle. In the hip flexion phase of kicking, the ball velocity was correlated with vertical (r=0.56)/anterior (r=0.46) position of COM in the NBP group.

To compensate for this restricted hip motion, the LBP group could extend and rotate their lumbar spine, which may likely cause stress to this region.

To compensate for this restricted hip motion, the LBP group could extend and rotate their lumbar spine, which may likely cause stress to this region.Steatosis is a condition of hepatic fat overload that is associated with overweight and the metabolic syndrome. Nonalcoholic fatty liver disease (NAFLD) has become the most common liver disease with a global impact on healthcare. A proportion of NAFLD patients develops nonalcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis or hepatocellular carcinoma (HCC). Identifying patients at risk for potentially life-threatening complications is crucial in their prevention, surveillance and treatment. In addition to hepatic disease progression (cirrhosis, portal hypertension, HCC), NAFLD patients are also at risk of cardiovascular and metabolic diseases as well as extrahepatic malignancies. Liver fibrosis is related to morbidity and mortality in NASH patients, and biomarkers, imaging techniques (ultrasound, elastography, MRI) as well as liver biopsy help in diagnosing fibrosis. In this review, we discuss the tools for identifying patients at risk and their reasonable application in clinical routine in order to stratify prevention and treatment of this emerging disease.

Emergency medical services (EMS) in India face enormous challenges in providing care to a geographically expansive and diverse patient population. Over the last decade, the public-private-partnership GVK EMRI (Emergency Management and Research Institute) has trained over 100,000 emergency medical technicians (EMTs), with greater than 21,000 currently practicing, to address this critical gap in the healthcare workforce. With the rapid development and expansion of EMS, certain aspects of specialty development have lagged behind, including continuing education requirements. To date, there have been no substantial continuing education EMT skills and training efforts. We report lessons learned during development and implementation of a continuing education course (CEC) for EMTs in India.

From 2014 to 2017, we employed an iterative process to design and launch a novel CEC focused on five core emergency competency areas (medicine and cardiology, obstetrics, trauma, pediatrics, and leadership and communication). ces, and cultural differences when developing impactful continuing educational initiatives in bourgeoning prehospital care systems in low- and middle-income countries.

These key strategies can be combined with innovation and flexibility to address unique challenges of language, system resources, and cultural differences when developing impactful continuing educational initiatives in bourgeoning prehospital care systems in low- and middle-income countries.With each successive update of the cardiopulmonary resuscitation (CPR) guidelines, the role of dispatchers in sudden cardiac arrest (CA) has grown. Dispatchers instruct callers in how to perform CPR until the arrival of emergency medical service (EMS) professionals. This is widely known as telephone CPR (TCPR) or dispatch-assisted CPR (DACPR). Studies have shown the efficacy of TCPR in increasing the survival rate of sudden CA. The TCPR process, however, is challenging and needs to be constantly evaluated and refined in order to improve the survival rate of sudden CA victims throughout the world. In this review article, the current status, challenges, and future perspectives of TCPR are discussed with a view to providing a research foundation from which to launch further studies into the effective role of dispatchers in sudden CA.

To summarize the evidence on the clinical effectiveness and safety of coronary sinus reducing stent (CSRS) therapy in refractory angina pectoris (AP) patients.

We performed a systematic literature search in common databases (n=4). The evidence obtained was summarized according to GRADE methodology. IOX1 in vitro A health technology assessment (HTA) was conducted using the HTA Core Model

for Rapid Relative Effectiveness Assessment. Primary outcomes for the clinical effectiveness domain were the proportion of patients with improvement in two or more Canadian Cardiovascular Society (CCS) angina score classes, overall mean reduction of CCS class, and Seattle Angina Questionnaire (SAQ) quality of life (QoL) score improvement. Outcomes for the safety domain were adverse device effects (ADEs) and serious adverse device effects (SADEs).

One randomized controlled trial (RCT) was identified. Outcomes that showed statistically significant differences between CSRS and sham treatment (in favor of CSRS) were CCS angina score improvement of one or two classes, overall mean reduction of CCS class, and SAQ QoL score improvement.