The effectiveness of T cell-mediated rejection (TCMR) therapy for achieving histological remission remains undefined in patients on modern immunosuppression. We systematically identified, critically appraised and summarized the incidence and histological outcomes after TCMR treatment in patients on tacrolimus (Tac) and mycophenolic acid (MPA). English-language publications were searched in MEDLINE (Ovid), Embase (Ovid), Cochrane Central (Ovid), CINAHL (EBSCO), Clinicaltrials.gov (NLM) up to January 2021. Study quality was assessed with National Institutes of Health Study Quality Tool. We pooled results using an inverse variance, random-effects model and report the binomial proportions with associated 95% confidence intervals (95% CI). Statistical heterogeneity was explored using the I² statistic. From 2,875 screened citations, we included 12 studies (1,255 participants). Fifty-eight percent were good/high quality while the rest were moderate quality. Thirty-nine percent of patients (95%CI 0.26-0.53, I² 77%) had persistent ≥Banff Borderline TCMR 2-9 months after anti-rejection therapy. Pulse steroids and augmented maintenance immunosuppression were mainstays of therapy, but considerable practice heterogeneity was present. A high proportion of biopsy-proven rejection exists after treatment emphasizing the importance of histology to characterize remission. Anti-rejection therapy is foundational to transplant management but well-designed clinical trials in patients on Tac/MPA immunosuppression are lacking to define the optimal therapeutic approach.

Objectives To summarise the current evidence regarding interventions for accurate and timely cancer diagnosis among symptomatic individuals. Design A scoping review following the Joanna Briggs Institute’s methodological framework for the conduct of scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Data sources MEDLINE (Ovid), CINAHL (EBSCOhost) and PsycINFO (Ovid) bibliographic databases, and websites of relevant organisations. Published and unpublished literature (grey literature) of any study type in the English language were searched for from January 2017 to January 2021. Eligibility and criteria Study participants were individuals of any age presenting at clinics with symptoms indicative of cancer. Interventions included practice guidelines, care pathways or other initiatives focused on achieving predefined benchmarks or targets for wait times, streamlined or rapid cancer diagnostic services, multidisciplinary teams and patient navigation strategies. Outcomes included accuracy and timeliness of cancer diagnosis. Data extraction and synthesis We summarised findings graphically and descriptively. Results From 21 298 retrieved citations, 88 unique published articles and 16 unique unpublished documents (on 18 study reports), met the eligibility for inclusion. About half of the published literature and 83% of the unpublished literature were from the UK. Most of the studies were on interventions in patients with lung cancer. Rapid referral pathways and technology for supporting and streamlining the cancer diagnosis process were the most studied interventions. Interventions were mostly complex and organisation-specific. Common themes among the studies that concluded intervention was effective were multidisciplinary collaboration and the use of a nurse navigator. Conclusions Multidisciplinary cooperation and involvement of a nurse navigator may be unique features to consider when designing, delivering and evaluating interventions focused on improving accurate and timely cancer diagnosis among symptomatic individuals. Future research should examine the effectiveness of the interventions identified through this review.

This study aimed to assess the effectiveness of ultrasonic denture hygiene interventions in improving denture cleanliness among elderly individuals. Sixty-six participants who had received upper metal framework removable partial dentures within the past 5 years were randomly allocated into three denture hygiene intervention groups: group 1 (mechanical cleaning with a toothbrush and ultrasonic cleaning with cetylpyridinium chloride), group 2 (mechanical cleaning with a toothbrush and ultrasonic cleaning with distilled water), and control (mechanical cleaning with a toothbrush only). Denture cleanliness was assessed at baseline and 1-month using: i) Denture Cleanliness Index (DCI) scores; ii) plaque coverage percentage; and (iii) microbiological samples for bacterial and yeast detection. Differences between groups were assessed with one-way analysis of variance and Chi-squared tests. Mean DCI scores and mean percentages of plaque coverage area were significantly reduced in group 1 and group 2, compared to the control group for both cobalt chromium (CoCr) and acrylic fitting surfaces (p<0.001). No significant differences were found between groups 1 and 2 with regard to the prevalence and viable counts of yeasts or total microbial viable counts. No significant differences in the investigated clinical and microbiological parameters were observed between CoCr and acrylic surfaces following the intervention period. The ultrasonic cleaner was significantly more effective than mechanical cleaning in the reduction of biofilm coverage on metal framework removable partial dentures over a 1-month intervention period. Nevertheless, the adjunctive use of cetylpyridinium chloride with ultrasonic cleaning did not yield additional benefits.

Primary immune thrombocytopenia (ITP) is a disorder characterized by enhanced platelet clearance and impaired production due to immune dysregulation. Central to its pathogenesis are platelet autoantibodies, T-cell–mediated processes, and altered cytokine profiles, which exacerbate clearance and hinder production. These mechanisms mirror other immune-mediated diseases and contribute to symptoms such as fatigue and thromboembolism. Despite extensive research, the inflammatory role in ITP remains unclear, with variability across studies underscoring the need for further investigation to optimize therapies. This study aims to summarize the evidence on inflammatory cytokines, inflammasomes, and neutrophil extracellular traps (NET) in adult primary ITP. A systematic literature review was conducted using Embase and MEDLINE (search date 9 January 2024), covering publications from the past decade. Observational studies and clinical trials reporting inflammatory markers were included (79 studies). Most studies were case-control (69.7%) and conducted in China (77.2%). Activation of multiple immune and inflammatory pathways was observed. T helper 17 (Th17; n = 21) and T follicular helper cells (n = 4) demonstrated involvement, with Th17-derived interleukin-17 (IL-17) contributing prominently to the inflammatory milieu. NLRP3 inflammasome hyperactivity/increased expression (n = 6 studies) emerged as a significant pathway, and strongly associated markers (IL-18 [n = 4]) were elevated. Additionally, NET and neutrophil activation promoted inflammation and thrombosis (n = 2). In conclusion, immune dysregulation from Th17 cell pathways and NLRP3 inflammasome strongly contribute to inflammation in adults with primary ITP, with IL-18 and IL-17 linked to disease activity/progression. The findings suggest a need for novel therapies to target immune dysregulation and clarify their roles in ITP.

Guidelines vary in defining severe hyperglyceridemia (sHTG), affecting estimates of disease burden. This review examined sHTG definitions in clinical guidelines and prevalence and incidence in the general adult population across countries. Embase and MEDLINE® were searched on 14 March, 2025 to identify guidelines on sHTG definitions and studies on prevalence/incidence. Prevalence estimates were stratified by triglyceride (TG) threshold to define sHTG type, with studies having substantial bias or methodological issues excluded from analysis. The most commonly used threshold for defining sHTG among 18 identified guidelines was TG > 500 mg/dL. Overall pooled prevalence estimates for unspecified/mixed (primary or secondary/acquired) sHTG defined as TG > 500 mg/dL, TG > 886 mg/dL, and TG > 1000 mg/dL were 1:88 (1.14%), 1:526 (0.19%), and 1:556 (0.18%), respectively. Population-based studies on primary sHTG were limited, with the United States (US) reporting prevalence of 1:125 (0.80%) and Spain 1:667 (0.15%) for sHTG defined as TG > 500 mg/dL. Incidence data were also scarce; for unspecified/mixed sHTG, Canada reported cumulative incidence of 1:400 adults for TG 886 to 1771 mg/dL and 1:2500 for TG > 1771 mg/dL, while Denmark reported incidence of 39 per 100,000 person-years for TG > 886 mg/dL. A US study reported 24 per 100,000 person-years for primary sHTG with TG > 500 mg/dL. This review highlights variability in sHTG definitions and prevalence/incidence across regions, with the US and China showing higher prevalence of sHTG than Europe. Standardization of nomenclature, definitions, and TG thresholds is necessary to improve comparability. Longitudinal studies should be conducted to identify patients with persistently elevated TGs to obtain more accurate estimates of sHTG incidence.