4th Edition Research Articles

Weighing the gold standard: The breadth of emergency medicine core content covered by textbooks.

Textbooks are often considered the criterion standard in medical education, but there is a growing preference for free open-access medical education (FOAM) content among learners. Despite FOAM's appeal, these resources often fall short in covering core content as comprehensively as the American Board of Emergency Medicine's 2019 Model of the Clinical Practice of Emergency Medicine (MCPEM), thereby sustaining the recommendation for textbook use. However, textbooks have limitations, such as how quickly content can become outdated. Notably, there is no evaluation of the comprehensiveness of emergency medicine (EM) textbooks in the literature. This observational cross-sectional study compared Rosen's Emergency Medicine: Concepts and Clinical Practice 10th Edition (Rosen's) and Tintinalli's Emergency Medicine: A Comprehensive Study Guide 9th Edition (Tintinalli's) with the MCPEM subtopics. Each textbook chapter was reviewed for content alignment with MCPEM subtopics. The primary outcome was the proportion of MCPEM subtopics covered by each textbook. Secondary outcomes included the count of chapters covering each topic and their distribution relative to the core content weighting in the ABEM National Qualifying Examination (NQE). Rosen's covered 95.3% of MCPEM subtopics (837 unique subtopics), and Tintinalli's covered 94.5% (826 unique subtopics). Both textbooks overrepresented topics like toxicology and psychobehavioral disorders compared to their weighting in the NQE. Relatively underrepresented topics included environmental disorders, cardiovascular disorders, renal and urogenital disorders, and traumatic disorders in Rosen's and other core competencies and cardiovascular disorders in Tintinalli's. The textbooks varied significantly in coverage of certain topics. Both Rosen's and Tintinalli's comprehensively cover MCPEM subtopics, with some discrepancies in topic representation compared to the NQE. While textbooks offer depth and breadth, they may not fully align with the NQE content distribution. A diversified approach to EM education, combining traditional textbooks and FOAM resources may be required for comprehensive learning.

Concurrent nimotuzumab and intensity-modulated radiotherapy for elderly patients with locally advanced nasopharyngeal carcinoma.

Because of the common physical condition, reduced organ function, and comorbidities, elderly patients with nasopharyngeal carcinoma (NPC) are often underrepresented in clinical trials. The optimal treatment of elderly patients with locally advanced NPC remains unclear. The purpose of this study was to evaluate the efficacy of concurrent nimotuzumab combined with intensity-modulated radiotherapy (IMRT) in elderly patients with locally advanced NPC. We conducted a single-arm, phase II trial for elderly patients with stage III-IVA NPC (according to UICC-American Joint Committee on Cancer TNM classification, 8th edition). All patients received concurrent nimotuzumab (200 mg/week, 1 week prior to IMRT) combined with IMRT. The primary end-point was complete response (CR) rate. The secondary end-points were survival, safety, and geriatric assessment. Between March 13, 2017 and November 12, 2018, 30 patients were enrolled. In total, 20 (66.7%) patients achieved CR, and objective response was observed in 30 (100.0%) patients 1 month after radiotherapy. The median follow-up time was 56.05 months (25th-75th percentile, 53.45-64.56 months). The 5-year locoregional relapse-free survival, distant metastasis-free survival, cancer-specific survival, disease-free survival, and overall survival were 89.4%, 86.4%, 85.9%, 76.5%, and 78.8%, respectively. Grade 3 mucositis occurred in 10 (33%) patients and grade 3 pneumonia in 3 (10%) patients. Concurrent nimotuzumab combined with IMRT is effective and well-tolerated for elderly patients with locally advanced NPC.

New classifications of B-cell neoplasms: a comparison of 5th WHO and International Consensus classifications.

In 2024, the World Health Organization (WHO) launched a new classification of lymphoid neoplasms, a revision of the previously used Revised 4th Edition of their classification (WHO-4R). However, this means that two classifications are now in simultaneous use: the 5th Edition of the WHO classification (WHO-5) and the International Consensus Classification (ICC). Instead of a comprehensive review of each disease entity, as already described elsewhere, this review focuses on revisions made in both the WHO-5 and ICC from WHO-4R and discrepancies between them regarding B-cell neoplasms. Similarities include cutaneous marginal zone lymphoma, cold agglutinin disease, non-primary effusion lymphoma-type effusion-based lymphoma, and gray zone lymphoma. Differences include plasma cell neoplasms, high-grade B-cell lymphoma (double hit lymphoma), follicular lymphoma, LPD with immune deficiency and dysregulation, extranodal large B-cell lymphoma, transformations of indolent B-cell lymphomas, and diffuse large B-cell lymphoma, not otherwise specified. Understanding the similarities and differences between the two latest classifications will aid daily diagnostic practice and future research on lymphoid neoplasms.

B-cell prolymphocytic leukemia: an enduring bona fide entity.

B-cell prolymphocytic leukemia (B-PLL) was recognized as a distinct entity in the fourth edition of the World Health Organization (WHO) classification for hematolymphoid neoplasms (WHO-HAEM4); however, its de novo presentation has been removed from the upcoming 5th edition classification (WHO-HAEM5). We present a case of a 65-year-old man with leukocytosis, fatigue, and no organomegaly by imaging. Bone marrow examination showed a prolymphocytoid population comprising 78% of the marrow elements. After thorough exclusion of other entities by clinical parameters and ancillary methods, we concluded that this case represents a de novo case of B-PLL.

Understanding of News Consumption Behavior among Millennials and Gen-X: A Comparative Study

In India, communication technology has brought huge changes in information consumption behaviour. In the country, people especially the young generation spend more time online for different purposes. According to 2021 data in India, around 840 million people use the internet, in which 448 million people use various social media and, according to the 10th edition of the Reuters Institute for the Study of Journalism's Digital News Report 2021, 82 present of Indians read the news online. Though, traditional media such as Radio, Newspapers, and Television also maintain their consistency in reaching people and providing various information to society. This scenario is rising the question that “does generational cohort influence on informationconsuming behaviour?, and if so, what types of information Millennials and Gen-X (Generation-X) would like to access or consume? In this frame, the study has comparatively analyzed the behaviour of Millennials and Gen-X in consuming various developmentrelated content that has been disseminated by both traditional and new media. Also, the study examined the development-related information coverage satisfaction level by media. For the study, 200 Millennials and Gen-X respondents were selected from the rural and urban area. Various statistical technics have been used to analysis the data with help of SPSS software.

Immune Deficiency/Dysregulation Associated Lymphoid Proliferations, EBV+ In Persons Living With HIV.

The 5th edition of the World Health Organization Classification of Hematolymphoid Tumors recently defined immune deficiency/dysregulation (IDD)-associated-lymphoid-proliferations in HIV settings, where information is scarce, often gone under or misdiagnosed. To describe the clinical picture, histopathology, and outcomes of IDD-associated-lymphoidproliferations Epstein-Barr virus+ (EBV) in people living with HIV without organ transplantation, antiretroviral therapy (ART) treated. HIV+ patients diagnosed with IDD-associated-lymphoid-proliferations seen at an academic medical center in Mexico from 2016 to 2019 were included. Immunohistochemical studies, in situ hybridization, and polymerase chain reaction analysis for EBV and LMP1 gene deletions were performed and correlated with clinical data. We included 27 patients, all men who have sex with men, median age 36 years (interquartile range [IQR] 22-54). The median baseline CD4+ T cells were 113/mL (IQR 89-243), the CD4+/CD8+ ratio was 0.15 (IQR: 0.09-0.22), and the HIV viral load was 184,280 copies/mL (IQR: 76,000-515,707). Twenty patients (74.07%) had IDD-associated-lymphoid-proliferations hyperplasia plasma cell type EBV+, 3 (11.1%) had hyperplasia mononucleosis-like type (IM-type), 1 patient (3.70%) had florid follicular hyperplasia, 3 (11.1%) IDD-associated-lymphoid-proliferations polymorphic type, and there were 22 cases (81.4%) of synchronic Kaposi Sarcoma. Two patients were diagnosed with Hodgkin lymphoma following a second positron emission tomography-computed tomography scan-guided biopsy. The median follow-up was 228 weeks (IQR 50-269); 6 patients died (22.2%) of causes unrelated to IDD-associated-lymphoid-proliferations related. IDD-associated-lymphoid-proliferations EBV+ occured in severely immunosuppressed HIV+ patients, a high percentage of whom had concomitant Kaposi sarcoma. The prognosis was good in patients treated only with ART.

A brief screener for impairment in personality functioning: Psychometric validation of the Five-Item Screening Scale for Personality Disorders in a Dutch-speaking clinical sample.

Personality disorders (PDs) are characterized by problems with identity and self-direction. Since the recent dimensional PD models of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems, 11th edition, the role of identity and self-direction in personality pathology has been made explicitly by including these problems in a general personality pathology criterion. This criterion reflects impairment in personality functioning (IPF), which is assessed on a continuum to determine the severity of personality pathology. The present study aimed to psychometrically evaluate the Five-Item Screening Scale for Personality Disorders (FISSPD; Skodol et al., 2011), a short screener for IPF, in a Dutch-speaking clinical sample of 820 adults. This screener mainly taps into self-related impairment, with four items measuring self-related impairment and one item measuring interpersonal impairment. The factor structure, scale reliability, measurement invariance (across sex, age, and patients with vs. without PD), and convergent validity were investigated. The Dutch FISSPD showed a unidimensional structure and good scale reliability. Scalar measurement invariance was established across sex, age (patients below vs. above age 40), and patients with versus without PD. The Dutch FISSPD was significantly related to identity and all DSM-IV/5 Section-II PD symptoms. The present study indicates that the Dutch FISSPD has potential as a reliable and valid screener for personality pathology in adult patients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Construction and validation of a novel tumor morphology immune inflammatory nutritional score (TIIN score) for intrahepatic cholangiocarcinoma: a multicenter study

BackgroundTumor morphology, immune function, inflammatory levels, and nutritional status play critical roles in the progression of intrahepatic cholangiocarcinoma (ICC). This multicenter study aimed to investigate the association between markers related to tumor morphology, immune function, inflammatory levels, and nutritional status with the prognosis of ICC patients. Additionally, a novel tumor morphology immune inflammatory nutritional score (TIIN score), integrating these factors was constructed.MethodsA retrospective analysis was performed on 418 patients who underwent radical surgical resection and had postoperative pathological confirmation of ICC between January 2016 and January 2020 at three medical centers. The cohort was divided into a training set (n = 272) and a validation set (n = 146). The prognostic significance of 16 relevant markers was assessed, and the TIIN score was derived using LASSO regression. Subsequently, the TIIN-nomogram models for OS and RFS were developed based on the TIIN score and the results of multivariate analysis. The predictive performance of the TIIN-nomogram models was evaluated using ROC survival curves, calibration curves, and clinical decision curve analysis (DCA).ResultsThe TIIN score, derived from albumin-to-alkaline phosphatase ratio (AAPR), albumin–globulin ratio (AGR), monocyte-to-lymphocyte ratio (MLR), and tumor burden score (TBS), effectively categorized patients into high-risk and low-risk groups using the optimal cutoff value. Compared to individual metrics, the TIIN score demonstrated superior predictive value for both OS and RFS. Furthermore, the TIIN score exhibited strong associations with clinical indicators including obstructive jaundice, CEA, CA19-9, Child–pugh grade, perineural invasion, and 8th edition AJCC N stage. Univariate and multivariate analysis confirmed the TIIN score as an independent risk factor for postoperative OS and RFS in ICC patients (p < 0.05). Notably, the TIIN-nomogram models for OS and RFS, constructed based on the multivariate analysis and incorporating the TIIN score, demonstrated excellent predictive ability for postoperative survival in ICC patients.ConclusionThe development and validation of the TIIN score, a comprehensive composite index incorporating tumor morphology, immune function, inflammatory level, and nutritional status, significantly contribute to the prognostic assessment of ICC patients. Furthermore, the successful application of the TIIN-nomogram prediction model underscores its potential as a valuable tool in guiding individualized treatment strategies for ICC patients. These findings emphasize the importance of personalized approaches in improving the clinical management and outcomes of ICC.

EBV-Positive Nodal T- and NK-Cell Lymphoma Mimicking Anaplastic Large Cell Lymphoma: A Case Report

EBV-positive nodal T- and NK-cell lymphoma (EBV+ NT/NKCL) is a recently recognized entity in the 5th edition of the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. Notably, CD30 positivity is frequently observed in (EBV+ NT/NKCL), creating diagnostic challenges to distinguish it from ALK-negative anaplastic large cell lymphoma (ALCL). Furthermore, cases of EBV+ ALCL have been documented in the literature, predating the inclusion of EBV+ nodal cytotoxic T-cell lymphoma as a variant of peripheral T-cell lymphoma. We present a case of a 47-year-old male presenting with multiple lymphadenopathies. The histomorphologic and immunophenotypic features of the lymph node closely resemble ALK-negative ALCL, characterized by uniform CD30 expression and a subcapsular distribution of lymphoma cells. However, the lymphoma cells exhibit diffuse positivity for EBV, consistent with EBV+ NT/NKCL. A case of ALK-negative ALCL with an immunophenotype identical to the EBV-positive case is included for comparison. Given that EBV+ NT/NKCL represents an aggressive neoplasm requiring unique clinical management compared to ALK-negative ALCL, it is critical to accurately differentiate EBV+ NT/NKCL from ALK-negative ALCL with a cytotoxic T-cell immunophenotype.

Effectiveness of online responsive teaching in young children with developmental disabilities: a pilot study.

Responsive teaching (RT) interventions, which enhance developmental outcomes by improving children's engagement behaviors, are traditionally delivered in person. However, the coronavirus disease 2019 pandemic complicated this approach. This study aimed to evaluate the efficacy and acceptance of online RT in children with developmental disabilities and their parents. This pilot study was conducted in Jinju, South Korea, and enrolled parent-child dyads referred to Gyeongsang National University Hospital for developmental concerns between April and September 2022. The children underwent a comprehensive developmental evaluation. The parents received a 5-session RT intervention via ZOOM on a mostly weekly basis. The first 2 sessions involved child development and RT lectures, while the others involved coaching on 3 of the 66 RT strategies. Problem behaviors, parent-child interactions, and parenting stress were assessed pre- versus postintervention using the Korean versions of the Child Behavior Checklist, Maternal/Child Behavior Rating Scale, and Parent Stress Index 4th Edition Short Form, respectively. Acceptability was evaluated using a self-administered questionnaire. Of the 30 recruited parent-child pairs, 23 (76%) completed the intervention and assessments. The children (mean age, 2.66±0.86 years) included 12 with language delays, 7 with autism spectrum disorder, and 4 with global delays. Predominantly mothers (96%) participated. Online RT significantly improved pivotal behaviors- including joint attention (P=0.04), cooperation (P=0.01), and affect (P=0.01)-and reduced overall problem behaviors (P=0.04). Parents reported less parenting stress (P=0.01), improved interactive behaviors with increased responsiveness (P<0.01), and decreased directiveness (P<0.01). High satisfaction with online RT interventions was also previously reported. These findings suggest that online RT can improve children's emotional and behavioral outcomes and maternal interaction styles and reduce parenting stress, offering accessible interventions amid challenges such as limited access and pandemics.

Convergence of the dimensional assessment of personality pathology (DAPP-BQ) and the five-factor personality inventory for the international classification of diseases 11th edition (FFiCD) in the context of the five-factor model and personality disorders

The current manuscript presents the convergence of the Dimensional Assessment of Personality Pathology (DAPP-BQ), using its short form the DAPP-90, and the Five-Factor Personality Inventory for International Classification of Diseases (ICD-11), the FFiCD, in the context of the five-factor personality model and the categorical approach of personality disorders (PDs). The current manuscript compares the predictive validity of both the FFiCD and the DAPP-90 regarding personality disorder scales and clusters. Results demonstrate a very high and meaningful convergence between the DAPP-90 and the FFiCD personality pathology models and a strong alignment with the FFM. The DAPP-90 and the FFiCD also present an almost identical predictive power of PDs. The DAPP-90 accounts for between 18% and 47%, and the FFiCD between 21% and 47% of PDs adjusted variance. It is concluded that both DAPP-90 and FFiCD questionnaires measure strongly similar pathological personality traits that could be described within the frame of the FFM. Additionally, both questionnaires predict a very similar percentage of the variance of personality disorders.

Systematic evaluation and meta-analysis of the prognosis of down-staging human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma using cetuximab combined with radiotherapy instead of cisplatin combined with radiotherapy.

To evaluate the efficacy and safety of cetuximab instead of cisplatin in combination with downstaging radiotherapy for papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC). Meta-analysis and systematic evaluation. The PubMed, Embase, Web of Science, and Cochrane library databases were searched up to June 8, 2023, as well as Clinicaltrials.gov Clinical Trials Registry, China Knowledge Network, Wanfang Data Knowledge Service Platform, and Wiprojournal.com. Randomized controlled trials reporting results of standard regimens of cetuximab + radiotherapy vs cisplatin + radiotherapy in treating HPV+ OPSCC were included. The primary outcomes of interest were overall survival (OS), progression-free survival (PFS), local regional failure rate (LRF), distant metastasis rate (DM), and adverse events (AE). Two reviewers independently extracted data and assessed the risk of bias of the included studies. The HR and its 95% CI were used as the effect analysis statistic for survival analysis, while the OR and its 95% CI were used as the effect analysis statistic for dichotomous variables. These statistics were extracted by the reviewers and aggregated using a fixed-effects model to synthesise the data. A total of 874 relevant papers were obtained from the initial search, and five papers that met the inclusion criteria were included; a total of 1,617 patients with HPV+ OPSCC were enrolled in these studies. Meta-analysis showed that OS and PFS were significantly shorter in the cetuximab + radiotherapy group of patients with HPV+ OPSCC compared with those in the conventional cisplatin + radiotherapy group (HR = 2.10, 95% CI [1.39-3.15], P = 0.0004; HR = 1.79, 95% CI [1.40-2.29], P < 0.0001); LRF and DM were significantly increased (HR = 2.22, 95% CI [1.58-3.11], P < 0.0001; HR = 1.66, 95% CI [1.07-2.58], P = 0.02), but there was no significant difference in overall grade 3 to 4, acute and late AE overall (OR = 0.86, 95% CI [0.65-1.13], P = 0.28). Cisplatin + radiotherapy remains the standard treatment for HPV+ OPSCC. According to the 7th edition AJCC/UICC criteria, low-risk HPV+ OPSCC patients with a smoking history of ≤ 10 packs/year and non-pharyngeal tumors not involved in lymphatic metastasis had similar survival outcomes with cetuximab/cisplatin + radiotherapy. However, further clinical trials are necessary to determine whether cetuximab + radiotherapy can replace cisplatin + radiotherapy for degraded treatment in individuals who meet the aforementioned characteristics, particularly those with platinum drug allergies. CRD42023445619.

Book review: Goldberger’s Clinical Electrocardiography. A Simplified Approach. 10th edition

Book review: Goldberger’s Clinical Electrocardiography. A Simplified Approach. 10th edition

Loco-Regional Ropivacaine Analgesia Via a Surgically Placed Intercostal Catheter after Anatomic Lung Resection: Prospective, Placebo-Controlled, Double-Blind; Randomized Superiority Trial

Abstract Background Even after minimally invasive anatomic lung resection, pain remains a burden for patients. Current guidelines recommend the surgical placement of intercostal catheters at the end of the surgery to promote faster recovery after lung surgery. Aims The aim of this trial was to investigate the analgesic efficacy of continuous loco-regional application of ropivacaine via an intercostal catheter and to establish this method as a possible standard of care in postoperative analgesia management. Methods Between December 2021 and October 2023, we evaluated the efficacy of surgically inserted intercostal catheters. Patients were eligible when undergoing anatomic VATS lung resection under general anesthesia for confirmed or suspected stage I lung cancer (UICC, 8th edition). Patients received ropivacaine at a concentration of 2 mg/ml or a placebo through an elastomer pump, flow rate of 6-8 ml/h for 72 hours after surgery. The sample size was calculated to find an NRS (numerical rating scale) difference associated with a pain reduction of 1.5 points. Results 14 patients were randomly included in the ropivacaine group and 18 in the placebo group. The patients’ characteristics and preoperative pain scores were similar in both groups. Between the observed groups there was no statistically significant difference in postoperative pain scores and morphine consumption. The NRS score for cough 24 hours postoperatively was 4.9 (±2.2) in the ropivacaine group and 4.3 (±2.4); p=0.474 in the placebo group. In addition, we were unable to determine any influence of the pain management on the relative postoperative pulmonary function. Conclusion Our results suggest that the analgesic efficacy of continuous loco-regionally applied ropivacaine administered through a surgically placed intercostal catheter after surgery does not have a positive effect on postoperative pain scores or morphine requirements. Instead, local analgesia started at the beginning of the procedure and covering several intercostal spaces should be considered.

Interpretation of the pathological diagnostic criteria and characteristics of high-grade thyroid follicular-derived carcinoma in the 5th edition WHO classification

The 5th edition WHO classification of thyroid tumors proposed high-grade non-anaplastic thyroid carcinoma, which includes traditional poorly differentiated thyroid carcinoma (PDTC) and differentiated high-grade thyroid carcinoma (DHGTC), with a prognosis between highly differentiated thyroid carcinoma and anaplastic thyroid carcinoma (ATC), in which about 50% of patients do not take radioactive iodine. Therefore, this classification is of great clinical significance. This article interprets the diagnostic criteria and genetic features of high-grade non-anaplastic thyroid carcinoma in 5th edition WHO classification, comparing with ATC.

Beyond omission: analysing the erasure of disability and inclusion in the developmentally appropriate practices

ABSTRACT The 4th edition of the National Association for the Education of Young Children’s (NAEYC) guidelines for developmentally appropriate practice (DAP) had an opportunity to provide the field an inclusive blueprint. While there was an attempt in this edition to respond to decades of critiques (e.g. Bloch [1992]. “Critical Perspectives on the Historical Relationship Between Child Development and Early Childhood Education Research.” In Reconceptualizing the Early Childhood Curriculum: Beginning the Dialogue, edited by S. Kessler, and E. B. Swadener, 3–20. New York, NY: Teachers College Press.; Cannella [1997]. Deconstructing Early Childhood Education: Social Justice and Revolution. New York, NY: Peter Lang.; Escayg [2019]. “Who’s got the Power?”: A Critical Examination of the Anti-Bias Curriculum.” International Journal of Child Care and Education Policy 13 (1): 1–18. https://doi.org/10.1186/s40723-019-0062-9.; Langford [2010]. “Critiquing Child-Centered Pedagogy to Bring Children and Early Childhood Educators Into the Center of a Democratic Pedagogy.” Contemporary Issues in Early Childhood 11 (1): 113–127. https://doi.org/10.2304/ciec.2010.11.1.113.; Pérez and Saavedra [2017]. “A Call for Onto-Epistemological Diversity in Early Childhood Education and Care: Centering Global South Conceptualizations of Childhood/s.” Review of Research in Education 41 (1): 1–29. https://doi.org/10.3102/0091732X16688621.; Souto-Manning and Rabadi-Raol [2018]. “(Re)Centering Quality in Early Childhood Education: Toward Intersectional Justice for Minoritized Children.” Review of Research in Education 42 (1): 203–225. https://doi.org/10.3102/0091732X187595.), the new edition continues to centre dominant developmental approaches where adults hyperfocus on children’s differences or individual characteristics rather than on changing educational structures and practices that promote inequity (Ferri and Bacon [2011]. “Beyond Inclusion: Disability Studies in Early Childhood Teacher Education.”). The revised guidelines do not go far enough to address inequity and to give teachers and programmes tools for addressing injustice for all young children. This manuscript builds on previous critiques of DAP by explicitly addressing the exclusion of disabled children from the guidelines.

Malignant Abrikossoff’s Tumour of the Tonsil - A Case Report of a Rare Entity

Abstract Rationale: This study aimed to report an uncommon site of origin of a rare head-and-neck cancer, namely malignant granular cell tumour. Patient Concerns: An 89-year-old female patient complained of persistent pharyngodynia and odynophagia for two months. Diagnosis: Upon clinical examination, the right palatine tonsil was larger and palpably firmer than the contralateral. An incisional biopsy of the lesion was performed under local anaesthesia revealing malignant granular cell tumour. A contrast-enhanced computed tomography (CECT) scan of the head and neck and an 18F-fluoro-2-deoxy-D-glucose positron emission tomography (PET) scan confirmed the presence of a pathologic appearance of the right palatine tonsil without nodal or distant metastasis. Treatment: Following a multidisciplinary consultation and the patient’s informed permission, a right tonsillectomy extended to the constrictor muscle fibres of the upper pharynx was performed. Outcomes: The tumour was staged as pT2 R0 cN0 M0, according to the AJCC 8th edition for soft-tissue tumours of the head and neck. Due to the early stage and the radicality of surgery, no further adjuvant treatments were provided. The patient is currently followed up with no evidence of disease one year post-operatively. Take-away Lessons: Granular cell tumours are rare mesenchymal tumours, firstly described by the pathologist Abrikossoff in 1926. This type of tumour constitutes approximately 0.5% of all soft-tissue tumours, and can affect any part of the body, with the head and neck being the most frequently involved site. The tonsil is an extremely rare localisation of this cancer. The differential diagnosis of unilateral tonsillar enlargement should also include this histological entity.

Neuropsychological profile associated with KAT6A syndrome: Emergent genotype-phenotype trends

BackgroundKAT6A (Arboleda-Tham) syndrome is a Mendelian disorder of the epigenetic machinery caused by pathogenic variants in the lysine acetyltransferase 6 A (KAT6A) gene. Intellectual disability and speech/language impairment (e.g., minimally verbal) are common features of the disorder, with late-truncating variants associated with a more severe form of intellectual disability. However, much of the cognitive phenotype remains elusive given the dearth of research.Participants and methodsThis study examined non-verbal and social skills of 15 individuals with molecularly-confirmed diagnoses of KAT6A syndrome (Mean age = 10.32 years, SD = 4.12). Participants completed select subtests from the DAS-II, the NEPSY-II, and the Beery Buktenica Developmental Test of Visual Motor Integration 6th Edition, and their caregivers completed an assortment of behavior rating inventories.ResultsFindings suggest global cognitive impairment with nonverbal cognition scores similar to those for receptive language. Autism-related features, particularly restricted interests and repetitive behaviors, and broad adaptive deficits were common in our sample juxtaposed with a relatively strong social drive and low frequency of internalizing and externalizing behavioral problems. A general trend of lower performance scores on nonverbal and receptive language measures was observed among those with protein-truncating variants vs. missense variants; however, no effect was observed on caregiver rating inventories of daily behaviors. Late and early truncating variants yielded comparable neuropsychological profiles.ConclusionsOverall, study results show the cognitive phenotype of KAT6A syndrome includes equally impaired nonverbal cognition and receptive language functioning, paired with relatively intact social drive and strengths in behavior regulation. Emergent genotype-phenotype correlations suggest cognition may be more affected in protein-truncating than missense mutations although similar neurobehavioral profiles were observed.

Trends in falls among older adults before and during the COVID-19 pandemic in Ontario, Canada: A retrospective observational study

BackgroundThe public health measures associated with the COVID-19 pandemic may have indirectly impacted other health outcomes, such as falls among older adults. The purpose of this study was to examine trends in fall-related hospitalizations and emergency department visits among older adults before and during the COVID-19 pandemic in Ontario, Canada.MethodsWe obtained fall-related hospitalizations (N = 301,945) and emergency department visit (N = 1,150,829) data from the Canadian Institute for Health Information databases from 2015 to 2022 for adults ages 65 and older in Ontario. Fall-related injuries were obtained using International Classification of Diseases, 10th edition, Canada codes. An interrupted time series analysis was used to model the change in weekly fall-related hospitalizations and emergency department visits before (January 6, 2015-March 16, 2020) and during (March 17, 2020-December 26, 2022) the pandemic.ResultsAfter adjusting for seasonality and population changes, an 8% decrease in fall-related hospitalizations [Relative Rate (RR) = 0.92, 95% Confidence Interval (CI): 0.85, 1.00] and a 23% decrease in fall-related emergency department visits (RR = 0.77, 95%CI: 0.59, 1.00) were observed immediately following the onset of the pandemic, followed by increasing trends during the pandemic for both outcomes.ConclusionsFollowing an abrupt decrease in hospitalizations and emergency department visits immediately following the onset of the pandemic, fall-related hospitalizations and emergency department visits have been increasing steadily and are approaching pre-pandemic levels. Further research exploring the factors contributing to these trends may inform future policies for public health emergencies that balance limiting the spread of disease among this population while supporting the physical, psychological, and social needs of this vulnerable group.

Serum AXL is a potential molecular marker for predicting COVID-19 progression.

The severity, symptoms, and outcome of COVID-19 is thought to be closely linked to how the virus enters host cells. This process involves the key roles of angiotensin-converting enzyme 2 (ACE2) and the Tyrosine protein kinase receptor UFO (AXL) receptors. However, there is limited research on the circulating levels of ACE2 and AXL and their implications in COVID-19. A control group of 71 uninfected individuals was also included in the study. According to the Guidance for Corona Virus Disease 2019 (10th edition), a cohort of 358 COVID-19 patients were categorized into non-severe and severe cases. Serum ACE2/AXL levels in COVID-19 patients were detected by enzyme-linked immunosorbent assay (ELISA) at different time points post-COVID-19 infection, including days 0-7, 8-15, 31-179 and >180 days. Serum SARS-CoV-2 IgG/IgM antibodies in COVID-19 patients at the same intervals were assessed by using an iFlash 3000 Chemiluminescence Immunoassay Analyzer. The receiver operating characteristic (ROC) curves were used to assess the diagnostic value of the biological markers, and the association between laboratory parameters and illness progression were explored. Compared with the uninfected group, the levels of ACE2 and AXL in the COVID-19 group were decreased, and the SARS-COV-2 IgG level was increased. AXL (AUC = 0.774) demonstrated a stronger predictive ability for COVID-19 than ACE2. In the first week after infection, only the level of AXL was statistically different between severe group and non-severe group. After first week, the levels of ACE2 and AXL were different in two groups. Moreover, in severe COVID-19 cases, the serum ACE2, AXL, and SARS-COV-2 IgM levels reached a peak during days 8-15 before declining, whereas serum SARS-COV-2 IgG levels continued to rise, reaching a peak at day 31-180 days before decreasing. In addition, the AXL level continued to decrease and the SARS-COV-2 IgG level continued to increase in the infected group after 180 days compared to the uninfected group. The levels of serum ACE2 and AXL correlate with COVID-19 severity. However, AXL can also provide early warning of clinical deterioration in the first week after infection. AXL appears to be a superior potential molecular marker for predicting COVID-19 progression.