Assaf Harofeh Medical Center

BackgroundFlight attendants (FAs) are subject to unique occupational demands, increasing their risk of developing work-related musculoskeletal pain (WRMSP). WRMSP is influenced by physical, psychosocial, and demographic factors that may change over time due to evolving work environments and practices.ObjectivesCompare the prevalence of FAs' WRMSP in 2016 vs 2024; Identify key physical and psychosocial predictors of WRMSP in each period; explore implications for ergonomic interventions and health promotion strategies tailored to the aviation work environment.MethodsTwo cross-sectional cohorts of FAs, from 2016 (n = 94) and 2024 (n = 89), completed identical, validated questionnaires using the same sampling frame. Surveys covered demographics, occupational tasks, region-specific pain, and psychosocial factors.ResultsArm and hand pain were less prevalent in 2024. Logistic regressions showed higher odds of neck pain in 2024 associated with stress, attitudes, and satisfaction, but markedly lower odds of arm pain across psychosocial and task factors. Lower back pain was less predicted in 2024 when satisfaction was considered. Across both years, hand pain increased with workload and oven-loading but decreased with age and authority; finger pain rose with effort; upper back pain with BMI and time pressure; shoulder pain with dissatisfaction; elbow pain with standing.ConclusionsTechnological and organizational changes appear to have contributed to reduced arm and hand pain and to lower back pain being less predicted in 2024, while psychosocial stressors were linked to increased neck pain, underscoring the dual impact of ergonomic improvements and persistent organizational pressures on WRMSP.

Overweight and obesity among physicians are increasingly recognized as relevant to workforce health, quality of care, and the credibility of lifestyle counseling delivered to patients. Physicians may face constraints that affect dietary patterns, physical activity, and daily routine, behaviors directly related to BMI. However, data linking specific lifestyle behaviors to BMI in this population remain limited. To examine associations between self-reported health behaviors and BMI among physicians and outline implications for workplace wellness. Cross-sectional online survey of physicians using the 26-item Healthy Lifestyle and Personal Control Questionnaire (HLPCQ). Participants were categorized into normal weight (BMI < 25) and overweight or obesity (BMI ≥ 25) groups based on their BMI. Group differences and multivariable logistic regression were applied. Of 200 respondents, 144 complete cases were analyzed; 54.2% had a BMI < 25. Higher BMI was associated with lower adherence to health-promoting behaviors, notably Dietary Harm Avoidance (p<0.01), Daily Routine (p=0.05), and Organized Physical Exercise (p=0.03). Regression analysis identified Dietary Harm Avoidance and Organized Physical Exercise as protective factors against overweight and obesity (p<0.01). Physicians in surgical specialties reported lower health behavior scores than non-surgical peers, particularly in Daily Routine (p<0.01) and in total lifestyle scores (p=0.01). Specific lifestyle behaviors, particularly dietary harm avoidance and organized physical activity, were associated with BMI among physicians. These associations may help inform future research on modifiable behavioral factors related to overweight and obesity among physicians.

To assess demographics, educational backgrounds, initial challenges, professional interests, and attitudes towards post-residency MD training among Oral and Maxillofacial Surgery (OMS) residents in Israel. Cross-sectional survey of 57 active OMS residents across all 9 accredited programs in Israel (June-October 2021). The questionnaire addressed demographics, educational background, residency experiences, challenges, professional interests, and future plans. Mean age was 34.6 years (67% male). Most (75.5%) graduated from Israeli dental schools, contrasting sharply with the general dental workforce (26% domestic graduates, P < 0.001). Primary challenges included adapting to hospital work demands (56.1%) and feeling overwhelmed by OMS knowledge requirements (54.4%). Residents with initial medical rotations reported significantly better adaptation (P = 0.047). Mediation analysis revealed that medical rotations improve adaptation partially through delayed overnight shift commencement. Trauma (63.2%), orthognathic surgery (52.6%), and oncologic surgery (35.1%) were areas of highest interest. Confidence in complex procedures increased significantly with training progression (P < 0.05). One-third planned post-residency MD training, with research degree holders more likely to pursue this path (OR = 2.76, P = 0.024). This study highlights improvement opportunities in Israeli OMS residency training, particularly structured early medical training and tailored support for international graduates.

Background: Longitudinal strain is central to the echocardiographic diagnosis of cardiac amyloidosis, typically showing reduced global values with relative apical sparing. Longitudinal displacement-an absolute measure of myocardial motion-may provide complementary diagnostic and physiological information. Methods: We retrospectively studied 24 patients with cardiac amyloidosis and 24 age-, sex-, rhythm-, and ejection fraction-matched controls. Global and regional longitudinal strain and displacement were calculated. Diagnostic performance was evaluated using receiver-operating characteristic (ROC) analysis, and reproducibility was assessed using intraclass correlation coefficients (ICC), coefficient of variation (CV), and Bland-Altman analysis. Results: In amyloidosis, both global longitudinal strain (GLS) and global longitudinal displacement (GLD) were significantly reduced compared with controls (GLS: -10.2 ± 2.6% vs. -20.1 ± 2.4%, p < 0.0001; GLD: 6.6 ± 1.9 mm vs. 11.9 ± 1.4 mm, p < 0.0001). Amyloidosis was characterized by pronounced impairment of basal displacement (9.0 ± 4.4 vs. 17.0 ± 3.9 mm, p < 0.0001) and only modest reduction in absolute apical motion (3.0 ± 2.4 vs. 5.0 ± 2.3 mm, p < 0.0001), supporting the concept that apical sparing observed on strain reflects relative rather than absolute preservation of function. ROC analysis demonstrated strong discriminatory performance within this cohort for GLD (cutoff 8.8 mm), basal displacement (~13 mm), and GLS (absolute 15.8%), with areas under the curve approaching 1.0. GLD and GLS correlated with indices of diastolic burden and functional status (E/E' and NYHA; |r| ≈ 0.32-0.41, all p ≤ 0.03). Reproducibility was good to excellent (ICC ≈ 0.84-0.89; CV 6-8%). Conclusions: Longitudinal displacement provides complementary and reproducible information alongside strain in cardiac amyloidosis. Combined assessment-reduced global or basal displacement together with reduced GLS and/or relative apical sparing-may refine the echocardiographic characterization of amyloid cardiomyopathy and link longitudinal mechanics to diastolic dysfunction and heart-failure burden.

Abstract Background Tasty&amp;Healthy (T&amp;H) is a whole food diet shown to induce clinical and biological remission in Crohn’s disease (CD)(1). It eliminates processed foods, gluten, red meat, and dairy (except plain yogurt); no formula or mandatory components are needed. Here we aimed to evaluate whether T&amp;H diet maintenance treatment induces radiologic and endoscopic remission while gradually reintroducing gluten and dairy. Methods Patients, aged 4–37 years, achieving deep remission (MINI index&amp;lt;8 and wPCDAI&amp;lt;12.5/CDAI&amp;lt;150) in the previous TASTI-MM (T&amp;H vs. EEN) and TASTI-E (T&amp;H vs. regular diet) induction RCTs, were enrolled in this open-label maintenance trial and completed 24 weeks on the diet. Gluten and dairy were reintroduced monthly; &amp;gt;30% increase in fecal calprotectin prompted re-elimination of the specific ingredient. Intestinal Ultrasound with Segmental Activity Scoring (IUS-SAS) was performed at weeks 0, 8 and 24 and, in a subset who consented, video capsule-endoscopy (VCE) or ileocolonoscopy at week 24. Results Forty-three patients were enrolled: age 16±5.8 years, 33 children/adolescents; 91% not receiving any therapy besides T&amp;H. Clinical remission at 24 weeks was maintained in 37/43 (86%) participants; 53% successfully re-introduced gluten and dairy. All IUS parameters improved from baseline to weeks 8 and 24 ( including the maximal bowel score (IBUS-SAS 44.9 [IQR 2.1-64.9], 14 [0-48.5], 13.6 [0-34,6]; p = 0.0068) and in the terminal ileum (43 [IQR 0-64.8], 14 [0- 47.5], 5 [0-31], respectively; p = 0.0069). Among 29 patients with paired IUS assessments at baseline and week 24, 86% showed improvement or normalization of the ileal IBUS-SAS score, and 83% (24/29) demonstrated improvement in both the maximal and panenteric cumulative scores. Of the 23 patients who underwent VCE/ileocolonoscopy, 14 (61%) exhibited complete endoscopic healing or had only a few aphthous ulcers. Conclusion The T&amp;H diet, combined with structured, calprotectin-guided reintroduction of gluten and dairy, maintained clinical remission and improved radiological and endoscopic inflammation in patients up to 24 weeks. Reference: 1. Aharoni-Frutkoff Y, Plotkin L, Pollak D, et al. Whole Food Diet Induces Remission in Children and Young Adults With Mild to Moderate Crohn’s Disease and Is More Tolerable Than Exclusive Enteral Nutrition: A Randomized Controlled Trial. Gastroenterology 2025. Conflict of interest: Plotkin, Luba: No conflict of interest Aharoni-Frutkoff, Yonat: No conflict of interest Shavit, Zivia: No conflict of interest Ms. Focht, Gili: No conflict of interest Livovsky, Jessica: No conflict of interest Lev Zion, Raffi: No conflict of interest Ledder, Oren: No conflict of interest Cytter- Kuint, Ruth: No conflict of interest Zharkov, Elena: No conflict of interest Broide, Efrat: No conflict of interest Assa, Amit: No conflict of interest Sigall-Boneh, Rotem: No conflict of interest Weiss, Batia: No conflict of interest Slae, Mordechai: No conflict of interest Dotan, Iris: No conflict of interest Godny, Lihi: No conflict of interest Kierkuś, Jarosław: No conflict of interest Griffiths, Anne: No conflict of interest Naftali, Timna: No conflict of interest Aloi, Marina: No conflict of interest Yerushalmy-Feler, Anat: No conflict of interest Schwerd, Tobias: No conflict of interest Reifen, Ram: No conflict of interest Turner, Dan: No conflict of interest

Abstract Background Tasty&amp;Healthy (T&amp;H) diet is an exclusion whole food diet shown to induce clinical and biological remission in Crohn’s disease (CD). We aimed to explore fecal and serum metabolomic response to T&amp;H vs. EEN and habitual diet arms in the TASTI-MM (T&amp;H vs. EEN) and TASTI-E (T&amp;H vs. habitual) RCTs. Methods We analyzed 670 serum and fecal metabolites at baseline, week 4 (fecal only) and week 8. Remission was defined by MINI index&amp;lt; 8 in TASTI-MM and by 50% decrease in calprotectin in TASTI-E. Univariate testing with multiple comparisons correction (FDR&amp;lt;0.25) were applied to each week, measured both in absolute level and in relative to baseline level. Principal component analysis (PCA) was applied for each metabolomics dataset to identify total signature shift or trends in metabolic patterns. Finally, metabolite set enrichment analysis (MESA) was applied to identify biological pathways associated with the diets using MetaboAnalyst v6.0, reporting pathway-level enrichment strength (Q statistic &amp;gt; 10) and significance (FDR &amp;lt; 0.05). Results Overall 121 children were enrolled in both RCTs with a total of 227 serum samples and 312 fecal samples collected over the RCTs’ duration with no observed metabolic differences at baseline. 140 serum and 63 fecal metabolites (in both weeks 4 and 8) consistently differed between T&amp;H and EEN in both absolute and relative comparisons. 17 serum metabolites consistently differed between T&amp;H and habitual diet in both absolute and relative comparisons while none differed in stool. PCA analysis showed overall metabolic shift in serum (Figure A) and fecal (Figure B) metabolomics signature in TASTI-MM, the most noticable shift was observed in stool at week 4, while a trend of metabolic shift in serum metabolomics was observed in TASTI-E. Both shifts were in concordance with differential metabolites detected in univariate analysis. MESA was used to infer biological interpretation which revealed in fecal metabolomics consistent and robust significant enrichment (Q-Statistic &amp;gt; 10, FDR &amp;lt; 0.05 at both weeks 4 and 8) of butyrate, histidine and tryptophan metabolism pathways in the T&amp;H group in comparison to EEN. Conclusion The T&amp;H diet promoted a distinct systemic metabolic signature which differed from those treated with EEN or continuing their habitual diet. The consistent and robust enrichment of butyrate, histidine and tryptophan metabolism pathways points to restoration of host–microbial amino acid and short-chain fatty acid networks that are implicated in intestinal homeostasis and immune regulation. Conflict of interest: Mr. Azulay, Asaf: No conflict of interest Plotkin, Luba: No conflict of interest Aharoni-Frutkoff, Yonat: No conflict of interest Livovsky, Jessica: No conflict of interest Focht, Gili: Other: Received in the past 3 years consultation fee from Lilly Lev Zion, Raffi: No conflict of interest Ledder, Oren: No conflict of interest Assa, Amit: No conflict of interest Yogev, Dotan: No conflict of interest Orlansky Meyer, Esther: No conflict of interest Broide, Efrat: No conflict of interest Kierkuś, Jarosław: Grant: Nestle Other: Nutricia, Abbvie, Nestle Kang, Ben: Other: For the past 3 years, Ben Kang has served as a speaker or consultant for Celltrion, Janssen, Eisai, Abbvie, Takeda, Yuhan, Yungjin, JW Pharmaceutical, and Samsung Bioepis and has received research funding from Celltrion. Weiss, Batia: No conflict of interest Aloi, Marina: Personal Fees: AbbVie Pfizer Dicofarm Slae, Mordechai: No conflict of interest Yerushalmy-Feler, Anat: No conflict of interest Wine, Eytan: Personal Fees: Janssen, AbbVie, Nestle Health Sciences, Mead Johnson Nutrition, Pfizer, BioJamp Turner, Dan: Consultation fee: Janssen, Pfizer, Ferring, Abbvie, Takeda, Prometheus Biosciences, Lilly, SorrisoPharma, Boehringer Ingelheim, Galapagos, BMS, AlfaSigma, Merck, Gentech Research support: Janssen, Abbvie, Takeda, Pfizer Royalties: Shaare Zedek Medical Center, Hospital for Sick Children

Genetics is a significant contributor to acute recurrent pancreatitis. This study evaluates the prevalence of genetic variants and assesses electrophysiological characteristics in Israeli patients. Patients with ≥2 episodes of acute pancreatitis, no history of drug use, normal IgG4 levels, and normal cholangiopancreatographic findings were included. Genetic analysis targeted the PRSS1, SPINK1, CTRC, CFTR, CPA1 , and TRPV6 genes, as well as the CEL-HYB1 allele. Sweat testing and nasal potential difference measurements were also performed. Seventy-nine patients (median age: 13y; range: 2-61) were referred between 2015 and 2021. Forty-five (57.0%) carried at least one genetic variant; 18 patients carried 2 or more variants. CFTR variants were the most common (35.4%), followed by PRSS1 (11.4%), SPINK1 (10.1%), and CTRC (10.1%). The rare PRSS1 p.Lys23Arg variant was prevalent among Jewish Georgian patients (n=8). Patients with genetic variants were younger than those without ( P <0.0035). Of the 71 patients who underwent nasal potential difference testing, 2 (5.6%) had abnormal results. Sweat test in 66 patients showed a mean value of 36 ± 16mmol/L; 6 had results above 60mmol/L; 2 of these carried CFTR variants TG[11]T[5] and p.Leu997Phe but had normal nasal potential. More than half of acute recurrent pancreatitis cases had a genetic basis, presenting at a younger age. CFTR variants were the most prevalent. The high prevalence of the PRSS1 p.Lys23Arg variant among Jewish Georgian individuals suggests a potential founder effect. These findings highlight the importance of genetic evaluation in the diagnosis and management of acute recurrent pancreatitis.

There are limited treatment options to improve vision in patients with infantile nystagmus. We aimed to examine the use of repeated visual stimulation with Gabor patches to improve vision. A prospective randomised (3:1) controlled single-blind study. Included were patients aged 9-55 years with infantile nystagmus, treated in one tertiary referral centre in central Israel. The treatment group underwent visual stimulation for 4 months, which consisted of treatment sessions of approximately 30 min, 3-4 times a week, using web-based dedicated software. Controls were followed without treatment. 26 patients were treated, and 10 served as controls. Mean age was 22.47±12 years. 12/26 (46%) of treated subjects achieved driving licence best corrected visual acuity (BCVA) (20/40) versus 1/10 (10%) of controls. Distance BCVA improved by 0.11±0.07 logMAR (one line) in treated patients compared with 0.013±0.06 logMAR in controls (p<0.001). Near BCVA improved by 0.20±0.18 logMAR (2 lines) in treated patients compared with 0.06±0.06 logMAR in controls (p=0.040). 88% (8/9) of study patients who had no stereopsis prior to treatment achieved stereopsis (mean 630') as opposed to 25% (1/4) of controls (p=0.10). Mean stereoacuity and contrast sensitivity improved by 802±730' and 292±391% in the study group as opposed to 246±376' and 152±67% in controls, respectively (p=0.031; p=0.157). Visual perceptual learning using Gabor patches resulted in a significant improvement in near and distance visual acuity, as well as stereopsis. This modality may represent a promising non-invasive treatment option for improving visual function in patients with infantile nystagmus.

Background/Objectives: Multiparametric MRI (mpMRI) and targeted biopsies have revolutionized prostate cancer (PC) detection through the Prostate Imaging Reporting and Data System (PIRADS). However, the effect of prostate volume on cancer detection and the predictive accuracy of PIRADS in the mpMRI-guided biopsy era remains unclear. The aim was to assess whether prostate volume affects detection rates of clinically significant prostate cancer (CSPC) and high-risk prostate cancer (HRPC) and modifies the predictive performance of the PIRADS score. Methods: We retrospectively analyzed 361 biopsy-naïve men who underwent mpMRI-fusion transperineal biopsies between 2016 and 2023. Lesions graded PIRADS ≥ 3 were targeted alongside systematic sampling. A receiver-operating characteristic (ROC) curve (AUC = 0.74) defined a 44 mL cutoff separating small (<44 mL; n = 160) and large (≥44 mL; n = 193) prostates. Logistic regression and cubic-spline analyses evaluated associations between prostate volume, PIRADS, and cancer outcomes. Results: Any cancer was detected in 74.3% of small versus 35.5% of large prostates (p < 0.001); CSPC in 42.5% vs. 19.6% (p < 0.001); HRPC in 14.3% vs. 5.5% (p < 0.001). Small prostate volume independently predicted any cancer (OR 7.31; 95% CI 4.22–12.7), CSPC (OR 5.08; 95% CI 2.87–8.99), and HRPC (OR 4.50; 95% CI 1.80–11.3). Between 40 and 70 mL, each 10 mL increase in volume reduced CSPC risk by 61% (p = 0.008). Prostate volume significantly modified PIRADS accuracy: in large glands, PIRADS 3 lesions carried only 2% risk for CSPC and 0% for HRPC, while in small prostates, PIRADS 3 conferred a 16.9-fold increased CSPC risk. Conclusions: Prostate volume inversely correlates with cancer detection and aggressiveness. PIRADS performance is volume-dependent; PIRADS 3 lesions in large prostates rarely represent significant cancer and may not warrant biopsy.