bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Thyroid Nodule by US Including Elastography versus MRI T2W and Diffusion Sequences
Authors: Mohamed Omar Mohamed Zaki , Maroof Rania , Elia Remon Zaher
Published: July 2024

Background

The thyroid gland frequently develops thyroid nodules. Effective treatment of malignant thyroid nodules depends on an early and accurate diagnosis. Benign and malignant thyroid nodules are typically distinguished using conventional thyroid ultrasonography (US). In order to explore changes in tissue stiffness, strain elastography (SE) uses an external force and a deformation response detector. A promising method for distinguishing between benign and malignant thyroid nodules is ultrasound elastography. Malignant versus benign thyroid nodules might be distinguished using MRI apparent diffusion coefficient (ADC) values. This study compares MRI T2W and diffusion sequences with ultrasound, which includes elastography, to assess thyroid nodules.

Methods

This cross-sectional research was carried out at Ain-Shams University's radiodiagnosis department. It included 23 female or male patients with suspicious thyroid nodule by clinical examination, or ultrasonography including some cases elastography if present for further work up with MR diffusion subjected to DWI and ADC value and results were compared with histopathology if present or follow up of the patients. The duration of the study was 24 months.

Results

Diffusion had an accuracy of 91.3%, while the ADC value and elastography had a greater diagnostic accuracy with an area under the curve of 95.7% in discriminating between benign and malignant cases.

Conclusions

When describing thyroid nodules, ADC value provided better diagnostic performance than US TIRADS rating. Over and above ACR-TIRADS classification, useful information is added by ultrasound elastography and strain ratio analysis of thyroid nodules. It is advised as an auxiliary tool. However, the distinction of cancerous and benign thyroid nodules might potentially be done with greater precision using diffusion weighted MRI.
Comparison of Aspiration versus Non-Aspiration Techniques in Fine-Needle Cytology of Thyroid Lesions
Authors: Ghazy Mohamed Shaker , Allam Allam El-sayed , Sayed Fatma Samy , Ragab Hamed Hassan Hamed
Published: July 2024

Background

Thyroid nodules are frequent among the general population. Ultrasound is the most commonly used imaging technique in the evaluation of thyroid nodules, Fine needle cytology (FNC) has been routinely used as the baseline investigation for diagnosis of nodular thyroid disease. Its advantages include minimal invasion and high sensitivity, specificity, and accuracy.

Objective

To compare the diagnostic quality of FNC sample obtained by aspiration versus non- aspiration techniques, aiming to improve the overall quality of FNC and hence better evaluation of thyroid nodules avoiding repeating FNC and unnecessary thyroidectomies.

Patients and Methods

Our study was conducted on 40 adult patients with thyroid nodules, whose ages range between 25 and 70 years old and were referred to undergo FNA procedures.

Results

40 patients with thyroid nodules were included in this study, our results showed statistically significant improvement in overall quality of the samples obtained by the non-aspiration (FNNAC) technique with less cellular trauma, less background blood, better preservation of cellular architecture and less cellular degeneration, however, there was no significant difference in the amount of the cellular material obtained and shows statistically significant difference regarding the diagnostic quality of the samples with more diagnostically superior samples were acquired by the FNNAC than by FNAC (50% and 5% respectively), while FNAC acquired more diagnostically adequate samples than FNNAC (75% and 50% respectively), non-diagnostic samples were only 20% with FNAC and 0% with FNNAC.

Conclusion

Both aspiration and non-aspiration techniques can be implemented and used for acquiring cytology samples, however, non-aspiration technique (FNNAC) was associated with overall better-quality samples with statistically significant better performance compared to FNAC. Non-aspiration technique is more convenient for both the patient and for the operator.
Positive Predictive Value of Thyroid Imaging, Reporting and Data System (TI-RADS) (3-5) When Compared to Fine Needle Aspiration Cytology Results
Authors: Mohammed Mahmoud Abdulrehman Mohiey , Abdelwahab Sameh Mohammed , Hassan Elhemeily Mohammad Hicham
Published: July 2024

Background

Thyroid nodules are a very common finding in the population. Evaluation of a patient with a thyroid nodule for possibility of malignancy could be challenging. Ultrasound is one tool that could be of help, several scoring systems are utilized to help differentiate benign from malignant nodules. One of the most used is TIRADS as proposed by ACR. Another invasive tool that could help is fine needle aspiration cytology.

Objective

Evaluating and comparing the accuracy of TI-RADS in the assessment of suspicious thyroid nodules by matching their results with the results of FNAC.

Patients and Methods

Our study was conducted on 72 adult patients with thyroid nodules and were referred to undergo FNA procedures in ‘Interventional radiology unit’ at the Radiology Department “Ain Shams University hospitals”, Cairo, Egypt.

Results

The present study concludes that TIRADS classification as proposed by ACR showed less statistical significance in predicting malignancy when compared to results of fine needle aspiration cytology. However, several components of the TIRADS scoring system were better predictors of malignancy than other components, namely the irregular margin, the taller than wider shape and the presence of calcifications within the nodule.

Conclusion

Our study concludes that better applying and implementing the TIRADS scoring system by the sonographer or using other scoring system available in evaluating thyroid nodules like ATA scoring system might result in more reliable ultrasound results decreasing the need to do fine needle aspiration.
The Predictive Value of Trancranial Ultrasound Doppler Parameters for Intracerebral Hemorrhage in Preterm and Low Birth Weight Neonates
Authors: Mohamed Abdulghaffar Marwa Mohamed , Shabana Aya Mohamed , Sayed Abd El-Karim Maha Ahmed , Allam Khaled Esmat
Published: July 2024

Background

Premature and low birth neonates are liable for many medical problems including intracranial hemorrhage. Transcranial Ultrasound examination and using different Doppler parameters of both ACA and MCA is considered as a good tool that is non invasive, cost effective and convenient to neonates to detect any intracerebral hemorrhage that they are risk for.

Aim of the Work

The aim of the current study was the assessment of the transcranial ultrasound as a predictive value of intracereberal hemorrhage in the examined neonates.

Patients and Methods

The study was performed on 33 preterm and low birth weight neonates attending Ain Shams University neonate intensive care unit and Ultrasound examination by B-Mode followed by Doppler examination were performed. Three neonates were died before performing the second examination. Examination was done at one day of birth considered as the first read and after 4-8 days which were considered as the second read to the rest 30 preterm neonates.

Results

Upon examination of 30 preterm and low birth neonates in two settings, they were categorized into hemorrhagic and non hemorrhagic groups. And by detecting the different Doppler parameters of both ACA and MCA in the two groups, it was found that the PSV2, MV, RI and PI gave a statistically significant difference between hemorrhagic and non hemorrhagic group. While ACA compared to MCA being has less branches and smaller diameter, its parameters are more sensitive in detection and prediction of hemorrhage than that of MCA. EDV1 of the ACA more than 8.1 cm/sec. was the most sensitive predictor of intracerebral hemorrhage in the present study.

Conclusion

In the current study, where more details examined upon ACA and MCA separately, it was found that EDV1 of the ACA has more predictive value than that of the EDV1 of MCA which is still can also used as a predictive value for intracranial hemorrhage.
Evaluation of the Prognostic Role of D-dimer in Egyptian Hepatocellular Carcinoma Patients Undergoing Locoregional Treatment
Authors: Zaki Ali Doaa Zakaria , Al fattah Shamkh Mostafa Abd , Abdelrady Maha Ahmed , Allam Allam al Sayed , Ahmed Ahmed Yasmine Saied
Published: July 2024

Background

The blood coagulation function is often abnormal in HCC patients due to hypercoagulatory state, hyperfibrinolytic state, and increased plasma D-dimer. HCC patients treated with locoregional treatment may show changes of D-dimer levels. Several studies explored the validity of D-dimer levels during locoregional treatment in HCC but definitive data are still lacking.

Aim of the Work

Determination of the efficacy of D-dimer profile as a prognostic marker regarding tumor features, and post interventional response in HCC subjects undergoing TACE or RFA.

Patients and Methods

The clinical data of 50HCC patients who underwent TACE or RFA in our hospital from October 2021 to June 2022 were collected, including the CBC, CRP Alfa-fetoproteins and plasma d-dimer level 1 week before TACE or RFA(D0), D-dimer level 1 month (D1) and 4 months(D2) after TACE or RFA. Contrast enhanced CT was performed within 1 week before locoregional treatment and was repeated 1month and 4 months after locoregional treatment to assess for treatment efficacy according to the mRECIST criteria based on change in tumor size as measured by CT scan. One month after TACE or RFA, these patients were divided into four groups according to the mRecist criteria: complete response, partial response, stationary disease and progressive disease. D0, D1 and D2 were compared between the 4 groups and the relation between D-dimer level and the efficacy of locoregional treatment was assessed.

Results

In patients with negative D-dimer before locoregional treatment (D0), there was no significant difference between D0 and D1 (P > 0.05), while patients with elevated pretreatment D-dimer levels (D0), D1 was significantly higher than D0 (P < 0.05) and the D1 is higher than that in patients with negative Do. Progressive rise of D-dimer levels 4months post locoregional treatment (D2) in HCC was associated with tumor progression suggesting aggressive tumor biology and poor outcome(P = 0.02).

Conclusion

The changes in plasma D-dimer level can be used as a potential prognostic biomarker in predicting the efficacy of locoregional treatment in HCC patients and thus, elevated D-dimer levels pre and post locoregional treatment may serve as predictors of adverse tumor profile and poor outcome.
Stimulated photosynthesis of regrowth after fire in coastal scrub vegetation: increased water or nutrient availability?
Authors: Rogers Erin I E , Mehnaz Kazi R , Ellsworth David S
Published: July 2024

Fire-prone landscapes experience frequent fires, disrupting above-ground biomass and altering below-ground soil nutrient availability. Augmentation of leaf nutrients or leaf water balance can both reduce limitations to photosynthesis and facilitate post-fire recovery in plants. These modes of fire responses are often studied separately and hence are rarely compared. We hypothesized that under severe burning, woody plants of a coastal scrub ecosystem would have higher rates of photosynthesis (Anet) than in unburned areas due to a transient release from leaf nutrient and water limitations, facilitating biomass recovery post-burn. To compare these fire recovery mechanisms in regrowing plants, we measured leaf gas exchange, leaf and soil N and P concentrations, and plant stomatal limitations in Australian native coastal scrub species across a burn sequence of sites at 1 year after severe fire, 7 years following a light controlled fire, and decades after any fire at North Head, Sydney, Australia. Recent burning stimulated increases in Anet by 20% over unburned trees and across three tree species. These species showed increases in total leaf N and P as a result of burning of 28% and 50% for these macronutrients, respectively, across the three species. The boost in leaf nutrients and stimulated leaf biochemical capacity for photosynthesis, alongside species-specific stomatal conductance (gs) increases, together contributed to increased photosynthetic rates after burning compared with the long-unburned area. Photosynthetic stimulation after burning occurred due to increases in nutrient concentrations in leaves, particularly N, as well as stomatal opening for some species. The findings suggest that changes in species photosynthesis and growth with increased future fire intensity or frequency may be facilitated by changes in leaf physiology after burning. On this basis, species dominance during regrowth depends on nutrient and water availability during post-fire recovery.
The Impact of Multi-Institution Datasets on the Generalizability of Machine Learning Prediction Models in the ICU
Authors: Rockenschaub Patrick , Hilbert Adam , Kossen Tabea , Elbers Paul , von Dincklage Falk , Madai Vince Istvan , Frey Dietmar
Published: July 2024

OBJECTIVES:

To evaluate the transferability of deep learning (DL) models for the early detection of adverse events to previously unseen hospitals.

DESIGN:

Retrospective observational cohort study utilizing harmonized intensive care data from four public datasets.

SETTING:

ICUs across Europe and the United States.

PATIENTS:

Adult patients admitted to the ICU for at least 6 hours who had good data quality.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Using carefully harmonized data from a total of 334,812 ICU stays, we systematically assessed the transferability of DL models for three common adverse events: death, acute kidney injury (AKI), and sepsis. We tested whether using more than one data source and/or algorithmically optimizing for generalizability during training improves model performance at new hospitals. We found that models achieved high area under the receiver operating characteristic (AUROC) for mortality (0.838–0.869), AKI (0.823–0.866), and sepsis (0.749–0.824) at the training hospital. As expected, AUROC dropped when models were applied at other hospitals, sometimes by as much as –0.200. Using more than one dataset for training mitigated the performance drop, with multicenter models performing roughly on par with the best single-center model. Dedicated methods promoting generalizability did not noticeably improve performance in our experiments.

CONCLUSIONS:

Our results emphasize the importance of diverse training data for DL-based risk prediction. They suggest that as data from more hospitals become available for training, models may become increasingly generalizable. Even so, good performance at a new hospital still depended on the inclusion of compatible hospitals during training.
Mutational profiling of 103 unresectable pancreatic ductal adenocarcinomas using EUS-guided fine-needle biopsy
Authors: Buchberg Julie , de Stricker Karin , Pfeiffer Per , Mortensen Michael Bau , Detlefsen Sönke
Published: July 2024

Background and Objective

Pancreatic ductal adenocarcinoma (PDAC) is among the most lethal cancers, with a 5-year survival rate of around 9%. Only 20% are candidates for surgery. Most unresectable patients undergo EUS-guided fine-needle biopsy (EUS-FNB) for diagnosis. Identification of targetable mutations using next-generation sequencing (NGS) is increasingly requested. Data on feasibility of EUS-FNB for NGS and knowledge regarding mutational profile of unresectable PDAC are scarce. We evaluated the “technical yield” of EUS-FNB for NGS in unresectable PDAC: relative fraction of diagnostic EUS-FNBs meeting technical criteria. We also investigated the “molecular yield”: relative fraction of EUS-FNBs included in NGS containing sufficient DNA for detection of at least one mutation. Furthermore, we determined the relative frequency of cancer-associated mutations in unresectable PDAC.

Patients and Methods

Formalin-fixed and paraffin-embedded EUS-FNBs diagnostic of unresectable PDAC and fulfilling these criteria were included (n= 105): minimum 3-mm2tissue, minimum of 2-mm2tumor area, and minimum 20% relative tumor area. NGS was performed using Ion GeneStudio S5 Prime System and Oncomine™ Comprehensive Assay v.3 including 161 cancer-related genes.

Results

Technical yield was 48% (105/219) and molecular yield was 98% (103/105). Most frequently mutated genes wereKRAS(89.3%) andTP53(69.9%), followed byCDKN2A(24.3%),ARID1A(9.7%),SMAD4(7.8%),TSC2(7.8%), andCCND3(6.8%).

Conclusion

EUS-FNB for NGS of unresectable PDAC is feasible. Our technical criteria for NGS, using leftovers in formalin-fixed and paraffin-embedded blocks after routine pathology diagnosis, were met by around half of EUS-FNBs. Almost all EUS-FNBs fulfilling the technical criteria yielded a successful NGS analysis.
Low-Intensity Heparin Infusion Compared With High-Intensity Heparin Infusion Dosing in Patients With Mechanical Mitral Valves: A Retrospective Cohort Study
Authors: Olsen Megumi , Adie Sarah K. , Divens Alyssa , Popova Kayla , Brancaccio Adamo
Published: July 2024

Patients with a mechanical mitral valve have an increased risk of thrombosis, and guidelines recommend a higher international normalized ratio goal for vitamin K antagonists–based anticoagulation. Guidelines provide recommendations for bridging with unfractionated heparin; however, there is no clear guidance on the heparin infusion intensity that should be used. This study was a retrospective, single-center, cohort study of patients aged ≥18 years or older with a mechanical mitral valve admitted from June 2019 to September 2022 who were maintained on a singular heparin infusion intensity nomogram for at least 48 hours. The patients were stratified into either a low- or a high-intensity heparin infusion nomogram. The exclusion criteria included non-nomogram heparin infusions and patients within 30 days of valve implantation. The primary outcome of this study was a composite of all bleeding events (major, clinically significant nonmajor, and minor bleeding). The secondary outcomes included bleeding events, analyzed individually, and thrombotic events. Seven total bleeding events were observed between the 2 groups, with 1 minor bleeding event in the low-intensity group and 6 bleeding events in the high-intensity group. One thrombotic event occurred in the high-intensity group. No statistically significant differences were found between the primary and secondary outcomes. Future studies are necessary to guide heparin infusion intensity selection in patients with mechanical mitral valves.
Impact of coronavirus disease 2019 on global access to assisted reproductive technologies services and related effects (2020–2021)
Authors: Ory Steven J.
Published: July 2024

Coronavirus disease 2019 had a major effect on access to reproductive health care services globally, which was most profound between April 2020 and May 2020. During that time, 82% of countries reported cessation or significant curtailment of reproductive clinical services pertaining to infertility care. Most countries had essentially returned to prepandemic levels of activity by January 2021. However, the magnitude of the longer-term sequelae including changes in family planning preferences and access to ongoing reproductive care, including contraception, is only now undergoing assessment.
Progestin-primed ovarian stimulation
Authors: Ata Baris
Published: July 2024

The use of progestins for the prevention of premature ovulation during ovarian stimulation is called progestin-primed ovarian stimulation (PPOS). Response to ovarian stimulation with PPOS and gonadotropin-releasing hormone (GnRH) analogs seem to be similar with the clinically insignificant differences being explained by endocrine characteristics as expected. PPOS has the advantage of oral administration and lower medication cost than GnRH analogs, but the mandatory cancellation of an otherwise possible fresh embryo transfer can render PPOS less cost-effective if a fresh transfer would have been possible. Oocytes collected in PPOS cycles have similar developmental potential, including blastocyst euploidy rates. Frozen embryo transfer outcomes of PPOS and GnRH analog cycles seem similar both in terms of ongoing pregnancy/live birth rates and obstetric and perinatal outcomes. While some studies reported lower cumulative live birth rates with PPOS, they suffer from methodological issues, including arbitrary definitions of cumulative live birth rates. PPOS has been used in all patient types with consistent results and seems a patient-friendly and cost-effective choice when a fresh embryo transfer is not intended.
Impact of temperature on ophthalmic viscosurgical devices and clinical implications: a pilot study
Authors: Henry Caoimhe , Castro Alejandro Thompson , Belkessa Mohamed , Rycroft Ewan , Syntouka Ioanna M. , Silva Andreia F. , Sillars Fiona , Oliveira Mónica S.N. , Lockington David
Published: July 2024

Purpose:

To evaluate how temperature affects the rheology of common ophthalmic viscosurgical devices (OVDs) and clinical implications.

Setting:

Tennent Institute of Ophthalmology, Glasgow, with Department of Mechanical and Aerospace Engineering, and Advanced Materials Research Laboratory, University of Strathclyde, Glasgow, United Kingdom.

Design:

Laboratory pilot study.

Methods:

The viscous and elastic responses of 3 OVDs (Eyefill-SC/Eyefill-C/Eyefill-HD) were measured using rotational and extensional rheometers at clinically relevant temperatures (5°C, 25°C, 37°C). Thermal properties were evaluated using differential scanning calorimetry and laser-flash analysis.

Results:

The OVDs tested exhibited viscoelastic properties and shear-thinning behavior. Apparent viscosities and relaxation time were higher at lower temperatures. The Eyefill-C and Eyefill-SC exhibited predominantly viscous character at low frequencies with a transition to predominantly elastic behavior at high frequencies. An increase in temperature led to a decrease in relaxation time under shear and extension. At low frequencies, Eyefill-C and Eyefill-SC moduli increase with decreasing temperatures. Eyefill-HD at 25°C and 37°C displays 2 crossover points, with the storage modulus dominating at low and high frequencies indicating a predominantly elastic behavior. Thermal property analysis revealed Eyefill-C had the lowest thermal conductivity.

Conclusions:

This pilot study confirms our clinical experience that OVD properties are affected by low temperatures, with increased viscosities at low shear rates and higher relaxation times. Cold OVD can cause greater resistance to initiation of intraocular lens (IOL) injection system forces (compared with warmer OVD). Excessively forced injection using cold OVD could contribute to inadvertent cannula detachment if incorrectly assembled, or uncontrolled IOL release leading to avoidable injury.
Comparison of keratometry and total corneal power, as measured by an SS-OCT–based optical biometer, for intraocular lens power calculation in Asian eyes
Authors: Savini Giacomo , Taroni Leonardo , Jeon Sohee , Koh Kyungmin , Yang Hyun Seung , Abulafia Adi , Lupardi Enrico , Hoffer Kenneth J. , Moramarco Antonio , Schiano-Lomoriello Domenico
Published: July 2024

Purpose:

To investigate whether standard keratometry (K) or total corneal power (TCP) leads to more accurate refractive outcomes for intraocular lens (IOL) power calculation.

Setting:

Public hospital.

Design:

Retrospective evaluation of a diagnostic test instrument.

Methods:

Preoperatively, all patients underwent optical biometry with Anterion, a swept-source optical coherence tomography device providing both K and TCP. The same IOL model was implanted in all cases. The whole sample was divided into a training dataset, used to optimize the formula constants, and a testing dataset, used to investigate the spherical equivalent prediction error (SEQ-PE) of 8 IOL power formulas. Trueness, precision, and accuracy were evaluated by means of the robust 2-sample t test. Cochran Q test was performed to assess whether the percentage of eyes with an SEQ-PE within each threshold was significantly different; in such an event, the McNemar test was then applied.

Results:

Both the training and testing datasets included 317 eyes. No significant differences were detected for trueness because of constant optimization. Precision and accuracy were better when K was entered, although a statistically significant difference was observed only with the EVO (precision: P = .02 and accuracy: P = .03) and Haigis (P < .01 for both precision and accuracy) formulas. No significant differences were observed for the percentage of eyes with an absolute SEQ-PE within any threshold.

Conclusions:

With most formulas, IOL power calculation is not more accurate when TCP is used instead of K.
Determining the Minimal Clinically Important Difference (MCID) and Responsiveness of the Chinese Version of Zurich Chronic Middle Ear Inventory (ZCMEI-21-Chn): A Prospective Multicenter Study
Authors: Yang Ruizhe , Zhang Ying , Feng Guodong , Han Weiju , Li Yi , Li Shan , Pan Tao , Ke Jia , Zhang Ke , Xin Ying , Song Yu , Zuo Qiang , Zhao Yanping , Zhou Na , Yao Ziming , Röösli Christof , Huber Alexander M. , Bächinger David , Ma Furong , Gao Zhiqiang
Published: July 2024

Objectives

This study aimed to establish the minimal clinically important difference (MCID) and assess the responsiveness of the Chinese version of Zurich Chronic Middle Ear Inventory (ZCMEI-21-Chn).

Study Design

Prospective multicenter study.

Setting

Four Chinese tertiary referral centers admitting patients nationwide.

Patients

230 adult patients with chronic otitis media (COM) undergoing tympanoplasty.

Intervention

Patients were required to complete the ZCMEI-21-Chn to measure health-related quality of life both preoperatively and postoperatively. An anchor-based method was used to determine the MCID of the derivative cohort by including the Global Rating of Change Questionnaire as an anchor. The generalizability and consistency with functional outcomes of the MCID estimates were externally examined in a validation cohort using a receiver operating characteristic curve analysis.

Results

A total of 161 and 69 patients were included in the derivative and validation cohort. The mean preoperative and postoperative ZCMEI-21-Chn total scores were 28.4 (standard deviation [SD] 14.5) and 17.5 (SD 12.6). The mean change in ZCMEI-21-Chn score was 10.9 (SD 14.3, p < 0.001). The MCIDs of the ZCMEI-21-Chn for improvement and deterioration were estimated at 13 (SD 13.0) and −7 (SD 12.9), accordingly. For patients who have reported an improved health-related quality of life, a cutoff value of 15.6 dB HL for elevation of the air-conducted hearing threshold was noticed. However, change of clinical importance judged according to MCID and Japan Otological Society criteria disagreed with each other, notably with a Cohen's kappa (κ) of 0.14 (p = 0.21) in the validation cohort.

Conclusion

This study is the first to establish the MCID of a COM-specific questionnaire in Chinese. For the COM population undergoing surgical intervention, MCID values of 13 for improvement and −7 for deterioration are recommended. The results were externally validated to be generalizable to nationwide usage, yet distinguishable from the audiological criteria. The availability of the MCID greatly adds to the clinical utility of the ZCMEI-21-Chn by enabling a clinically meaningful interpretation of its score changes.
Pulmonary vascular disease in chronic lung diseases: cause or comorbidity?
Authors: Blanco Isabel , Torres-Castro Rodrigo , Barberà Joan Albert
Published: July 2024

Purpose of review

To provide timely and relevant insights into the complex relationship between pulmonary vascular disease (PVD) and chronic lung disease (CLD), focusing on the causative and consequential dynamics between these conditions.

Recent findings

There are shared pathogenic mechanisms between pulmonary arterial hypertension (PAH) and group 3 pulmonary hypertension, including altered expression of mediators and growth factors implicated in both conditions. Factors such as hypoxia, hypoxemia, and hypercapnia also contribute to pulmonary vascular remodelling and endothelial dysfunction. However, the role of hypoxia as the sole driver of pulmonary hypertension in CLD is being reconsidered, particularly in chronic obstructive pulmonary disease (COPD), with evidence suggesting a potential role for cigarette smoke products in initiating pulmonary vascular impairment. On the other hand, interstitial lung disease (ILD) encompasses a group of heterogeneous lung disorders characterized by inflammation and fibrosis of the interstitium, leading to impaired gas exchange and progressive respiratory decline, which could also play a role as a cause of pulmonary hypertension.

Understanding the intricate interplay between the pulmonary vascular compartment and the parenchymal and airway compartments in respiratory disease is crucial for developing effective diagnostic and therapeutic strategies for patients with PVD and CLD, with implications for both clinical practice and research.
Updates on postinfectious skin rashes in pediatric dermatology
Authors: Daniel Samantha Shwe , Peterman Caitlin , Awasthi Smita
Published: July 2024

Purpose of review

This review provides updates on postinfectious skin rashes in the pediatric population from recently published literature.

Recent findings

The COVID-19 pandemic and its sequelae remain a focus of research on pediatric infectious skin rashes. Multisystem inflammatory syndrome in children (MIS-C) and reactive infectious mucocutaneous eruption (RIME) are common complications of infection with SARS-COV-2 in the pediatric population. Most cases of MIS-C show low mortality and suggest mucocutaneous symptoms do not correlate with COVID-19 disease severity. Cases of papular acrodermatitis of childhood, also known as Gianotti–Crosti, have also been reported in association with SARS-COV-2, and can present similarly in reaction to other viral infection like molluscum contagiosum, known as a Gianotti–Crosti syndrome-like reaction (GCLR). Other relevant studies on postinfectious skin rashes include updates on the management of staphylococcal scalded skin syndrome (SSSS), with newer evidence advocating for beta-lactam monotherapy without clindamycin and reduced ancillary testing. Finally, the emergence of antifungal resistance due to Trichophyton indotinae is a growing global health concern emphasizing the need for improved antifungal stewardship.

It is prudent for clinicians to be informed of both common and rare diagnoses that have emerged more recently in association with the COVID-19 pandemic, in addition to other diseases with newer evidence-based recommendations to guide management.
Blenderized tube feeding in pediatrics – current evidence, guidelines, and considerations
Authors: Allen Lindsay , Min James , Zong Wenjing
Published: July 2024

Purpose of review

Recently, blenderized tube feeding (BTF) consisting of blended whole food components is emerging as a preferred approach to enteral nutrition in pediatric patients. Differences in the nutritional profile, viscosity, and other characteristics between BTF and conventional tube feeding formulas may impact clinical outcomes and practice considerations.

Recent findings

Increasing guidance and evidence are emerging for BTF in pediatric populations requiring tube feeding. The characteristics of each BTF formulation vary, which may affect patient tolerance and clinical outcome.

BTF is safe and generally well tolerated in children. It is shown to improve symptoms, clinical outcomes, and quality of life for many patients. A thorough risk assessment and nuanced approach may be required to optimize BTF administration.
Pearls for practice from the 2023 allergy immunology joint task force on practice parameters GRADE and institute of medicine based atopic dermatitis guidelines
Authors: Conway Alexandra E. , Kartha Navya , Maddukuri Chaitanya , Shaker Marcus S.
Published: July 2024

Purpose of review

To review the updated 2023 Allergy Immunology Joint Task Force on Practice Parameters (JTFPP) GRADE and Institute of Medicine (IOM) Based Guidelines for the management of atopic dermatitis.

Recent findings

Topical corticosteroids and/or calcineurin inhibitors are recommended in individuals with atopic dermatitis refractory to moisturizer alone and may be used to maintain remission after acute flare control is achieved. Calcineurin inhibitors are a class of immunosuppressants used to effectively manage different autoimmune disorders. Bleach baths and allergen immunotherapy may be beneficial for individuals with moderate-to-severe disease, while elimination diets, azathioprine, methotrexate, mycophenolate, and systemic corticosteroids are not recommended. Dupilumab is strongly recommended for refractory atopic dermatitis. Oral Janus kinase (JAK) inhibitors carry significant risks; however, this class of medicines may be considered in cases of severe or refractory atopic dermatitis with intolerance to dupilumab. Patient preferences regarding cost, availability, feasibility, and tolerability should be integrated into all treatment plans using a shared decision-making approach.

The 2023 JTFPP Atopic Dermatitis Guidelines offer up-to-date guidance for the management of atopic dermatitis of varying severity in infants, children, and adults.
Optimizing management of chronic pulmonary hypertension in preterm infants: strategies for a complex population
Authors: Michel-Macías Carolina , Hébert Audrey , Altit Gabriel
Published: July 2024

Purpose of review

Pulmonary hypertension (PH) is commonly observed in premature infants with bronchopulmonary dysplasia (BPD) and is associated with poor outcomes and increased mortality. This review explores the management of this intricate condition of the pulmonary vasculature, which exhibits heterogeneous effects and may involve both arterial and postcapillary components.

Recent findings

Current management of BPD-PH should focus on optimizing ventilatory support, which involves treatment of underlying lung disease, transitioning to a chronic phase ventilation strategy and evaluation of the airway. Data on management is limited to observational studies. Diuretics are considered a part of the initial management, particularly in infants with right ventricular dilation. In many cases, pulmonary vasodilator therapy is required to induce pulmonary arterial vasodilation, reduce right ventricular strain, and prevent coronary ischemia and heart failure. Echocardiography plays a pivotal role in guiding treatment decisions and monitoring disease progression.

BPD-PH confers a heightened risk of mortality and long-term cardio-respiratory adverse outcomes. Echocardiography has been advocated for screening, while catheterization allows for confirmation in select more complex cases. Successful management of BPD-PH requires a multidisciplinary approach, focusing on optimizing BPD treatment and addressing underlying pathologies.
Anticoagulant Medications: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference
Authors: Cashen Katherine , Saini Arun , Brandão Leonardo R. , Le Jennifer , Monagle Paul , Moynihan Katie M. , Ryerson Lindsay M. , Gehred Alison , Lyman Elizabeth , Muszynski Jennifer A. , Alexander Peta M.A. , Dalton Heidi J ,   for the Pediatric Extracorporeal Membrane Oxygenation (ECMO) Anticoagulation CollaborativE (PEACE), in collaboration with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support Organization (PediECMO)
Published: July 2024

OBJECTIVES:

To derive systematic-review informed, modified Delphi consensus regarding the medications used for anticoagulation for pediatric extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE (PEACE).

DATA SOURCES:

A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021.

STUDY SELECTION:

Included studies assessed anticoagulation used in pediatric ECMO.

DATA EXTRACTION:

Two authors reviewed all citations independently, with a third reviewer adjudicating any conflicts. Eighteen references were used for data extraction as well as for creation of recommendations. Evidence tables were constructed using a standardized data extraction form.

DATA SYNTHESIS:

Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. Forty-eight experts met over 2 years to develop evidence-informed recommendations and, when evidence was lacking, expert-based consensus statements, or good practice statements for anticoagulation during pediatric ECMO. A web-based modified Delphi process was used to build consensus via the Research and Development/University of California Appropriateness Method. Consensus was based on a modified Delphi process with agreement defined as greater than 80%. Two recommendations, two consensus statements, and one good practice statement were developed, and, in all, agreement greater than 80% was reached.

CONCLUSIONS:

There is insufficient evidence to formulate optimal anticoagulation therapy during pediatric ECMO. Additional high-quality research is needed to inform evidence-based practice for anticoagulation during pediatric ECMO.
Symptoms Patterns and Health-Related Quality of Life in a Real-Life Cohort of Long-COVID Patients
Authors: Maccarone Maria Chiara , Coraci Daniele , Regazzo Gianluca , Masiero Stefano
Published: July 2024

Objective

We wanted to identify prevalent symptoms and patterns of long-COVID syndrome, assess the impact on health-related quality of life, and explore factors linked to lower quality of life, including vaccination status and symptom count, in a real-life cohort.

Design

This is an observational retrospective study.

Results

We assessed 133 patients and 85 completed the evaluations. The most common symptoms reported were motor deficit (95.29%) and fatigue (94.12%), while respiratory symptoms, cognitive deficits, and weakness (76.47%) were less frequent. Many patients experienced multiple symptoms, with the majority reporting 5–8 symptoms simultaneously, most associated with fatigue. However, the number of symptoms did not correlate with health-related quality of life as measured by the 12-Item Short Form Survey questionnaire. Finally, vaccination status did not significantly affect 12-Item Short Form Survey scores or the number of reported symptoms.

Conclusions

Our analysis highlighted the presence of diverse multisystemic symptoms in long-COVID patients. Many individuals experienced multiple associated symptoms, negatively affecting their overall quality of life. Neither vaccination status nor the number of symptoms appeared to influence reported quality of life. This emphasizes the need for a comprehensive, early, and multidisciplinary approach to address the syndrome’s diverse symptoms.
Peripheral Nerve Stimulation of the Axillary Nerve Improves Chronic Shoulder Pain and Dysfunction Following Reverse Total Shoulder Arthroplasty: A Case Report
Authors: Pierson Chris J. , Javed Nashra , Jain Nitin B. , Konda Chaitanya
Published: July 2024

Reverse total shoulder arthroplasty (rTSA) is an effective procedure to improve shoulder pain, range of motion, and function for a variety of conditions, including glenohumeral osteoarthritis and rotator cuff arthropathy. However, up to 22% of patients have persistent shoulder pain 12 to 24 months following rTSA, even in the absence of surgical complications. Currently, there are no widely accepted non-pharmacological treatments for persistent postoperative pain after rTSA. This case report details the successful management of a 64-year-old woman with chronic postoperative shoulder pain following rTSA. She was treated with single-lead percutaneous peripheral nerve stimulation to the right axillary nerve for eight weeks with 12 Hz motor-level stimulation. She demonstrated improvement in shoulder flexion active range of motion, shoulder flexion strength, and shoulder abduction strength. Her Shoulder Pain and Disability Index total score improved from 26.93% to 8.46% one year following treatment. She reported an overall Global Rating of Change of +7 one year following treatment. This case’s success demonstrates that short term peripheral nerve stimulation may provide long-term improvement of persistent post-operative pain and dysfunction in patients with painful rTSA.
Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO
Authors: Solberg Nes Lise , Børøsund Elin , Varsi Cecilie , Eide Hilde , Waxenberg Lori B. , Weiss Karen E. , Morrison Eleshia J. , Støle Hanne Stavenes , Kristjansdottir Ólöf B. , Bostrøm Katrine , Strand Elin Bolle , Hagen Milada Cvancarova Småstuen , Stubhaug Audun , Schreurs Karlein M.G.
Published: July 2024

Introduction:

Chronic pain affects a wide range of physical and psychological aspects of life for those impacted. Psychosocial treatment approaches may be of support, but outreach is still limited.

Objectives:

To evaluate the efficacy of EPIO, an evidence-informed, user-centered digital self-management intervention for people with chronic pain, in a 12-month randomized controlled trial.

Methods:

People living with chronic pain (N = 266) were randomized to the EPIO intervention (n = 132) or a usual-care control group (n = 134). The intervention was delivered in a simple blended care model, and outcome measures collected at baseline, 6 months, and 12 months. Generalized linear models for repeated measures were fitted to compare groups over time.

Results:

Participants were primarily female (81%), median age 49 years (range 22–78), with heterogeneous pain conditions, and had lived with pain >5 years (77.6%). A mixed linear model with all timepoints included revealed no statistically significant group differences for the primary outcome of pain interference. Significant psychological benefits in favor of the intervention group were however detected for depression (P = 0.022), self-regulatory fatigue (P = 0.024), vitality (P = 0.016), and mental health (P = 0.047). Baseline to 12-month changes showed additional favorable effects for anxiety (between-group mean differences [MDs] = 0.79, P = 0.047), depression (MD = 1.08, P = 0.004), self-regulatory fatigue (MD = 2.42, P = 0.021), pain catastrophizing (MD = 2.62, P = 0.009), and health-related quality of life.

Conclusions:

The EPIO program aims to improve outreach of evidence-based pain self-management interventions. Findings demonstrate how using EPIO can lead to sustainable psychological change, enhancing mental health and health-related quality of life for people suffering from pain, providing a chance to live well with the pain.
Stepwise developmental mimicry generates proximal-biased kidney organoids
Authors: Schnell Jack , Miao Zhen , Achieng MaryAnne , Fausto Connor C. , Wang Victoria , Kuyper Faith De , Thornton Matthew E. , Grubbs Brendan , Kim Junhyong , Lindström Nils O.
Published: July 2024

The kidney maintains body fluid homeostasis by reabsorbing essential compounds and excreting waste. Proximal tubule cells, crucial for renal reabsorption of a range of sugars, ions, and amino acids, are highly susceptible to damage, leading to pathologies necessitating dialysis and kidney transplants. While human pluripotent stem cell-derived kidney organoids are used for modeling renal development, disease, and injury, the formation of proximal nephron cells in these 3D structures is incomplete. Here, we describe how to drive the development of proximal tubule precursors in kidney organoids by following a blueprint ofin vivohuman nephrogenesis. Transient manipulation of the PI3K signaling pathway activates Notch signaling in the early nephron and drives nephrons toward a proximal precursor state. These “proximal-biased” (PB) organoid nephrons proceed to generate proximal nephron precursor cells. Single-cell transcriptional analyses across the organoid nephron differentiation, comparing control and PB types, confirm the requirement of transient Notch signaling for proximal development. Indicative of functional maturity, PB organoids demonstrate dextran and albumin uptake, akin toin vivoproximal tubules. Moreover, PB organoids are highly sensitive to nephrotoxic agents, display an injury response, and drive expression ofHAVCR1/KIM1, an early proximal-specific marker of kidney injury. Injured PB organoids show evidence of collapsed tubules, DNA damage, and upregulate the injury-response markerSOX9. The PB organoid model therefore has functional relevance and potential for modeling mechanisms underpinning nephron injury. These advances improve the use of iPSC-derived kidney organoids as tools to understand developmental nephrology, model disease, test novel therapeutics, and for understanding human renal physiology.
Single cell transcriptome profiling reveals pathogenesis of Bullous Pemphigoid
Authors: Wang Yetao , Liang Guirong , Zhao Chenjing , Wei Qin , Feng Suying
Published: July 2024

Bullous Pemphigoid (BP) triggers profound functional changes in both non-immune and immune cells in the skin and circulation, yet the underlying mechanisms remain elusive. In this study, we conducted single-cell transcriptome analysis on donor-matched lesional and non-lesional skin, as well as blood samples from BP patients. Lesional skin non-immune cells coordinately upregulated metabolism, wound healing, immune activation, and cell migration associated pathways. Skin LAMP3+ DCs derived from cDC2 exhibited higher pro-inflammatory signatures than those from cDC1, and VEGFA+ mast cells driving BP progression, were predominantly from lesional skin. As BP patients transition from active to remission stages, blood B cell function shifts from differentiation and memory formation to heightened type 1 interferon signaling and reduced IL-4 response. Blood CX3CR1+ZNF683+ and LAG3+ exhausted T cells exhibited the highest TCR expansion among clones shared with skin CD8+T cells, suggesting they likely represent BP-reactive cells fueling skin CD8+T cell clonal expansion. Clinical parameters for BP severity correlated positively with blood NK cell IFN-gamma production, whereas correlated negatively with NK cell AREG production. In lesional skin, NK cell-keratinocyte interactions exhibited reduced AREG-EGFR and enhanced IFNG-IFNGR1/2 signaling. NK cell-derived AREG mitigates IFN-gamma-induced keratinocyte apoptosis, highlighting a crucial balance between AREG and IFN-gamma in BP progression. These results reveal significant functional shifts in BP pathology within skin and blood cells and suggest new therapeutic targets for disease management.