Additional Tests Research Articles

Hydrocortisone plus fludrocortisone for community acquired pneumonia-related septic shock: a subgroup analysis of the APROCCHSS phase 3 randomised trial

Glucocorticoids probably improve outcomes in patients hospitalised for community acquired pneumonia (CAP). In this a priori planned exploratory subgroup analysis of the phase 3 randomised controlled Activated Protein C and Corticosteroids for Human Septic Shock (APROCCHSS) trial, we aimed to investigate responses to hydrocortisone plus fludrocortisone between CAP and non-CAP related septic shock. APROCCHSS was a randomised controlled trial that investigated the effects of hydrocortisone plus fludrocortisone, drotrecogin-alfa (activated), or both on mortality in septic shock in a two-by-two factorial design; after drotrecogin-alfa was withdrawn on October 2011, from the market, the trial continued on two parallel groups. It was conducted in 34 centres in France. In this subgroup study, patients with CAP were a preselected subgroup for an exploratory secondary analysis of the APROCCHSS trial of hydrocortisone plus fludrocortisone in septic shock. Adults with septic shock were randomised 1:1 to receive, in a double-blind manner, a 7-day treatment with daily administration of intravenous hydrocortisone 50 mg bolus every 6h and a tablet of 50 μg of fludrocortisone via the nasogastric tube, or their placebos. The primary outcome was 90-day all-cause mortality. Secondary outcomes included all-cause mortality at intensive care unit (ICU) and hospital discharge, 28-day and 180-day mortality, the number of days alive and free of vasopressors, mechanical ventilation, or organ failure, and ICU and hospital free-days to 90-days. Analysis was done in the intention-to-treat population. The trial was registered at ClinicalTrials.gov (NCT00625209). Of 1241 patients included in the APROCCHSS trial, CAP could not be ruled in or out in 31 patients, 562 had a diagnosis of CAP (279 in the placebo group and 283 in the corticosteroid group), and 648 patients did not have CAP (329 in the placebo group and 319 in the corticosteroid group). In patients with CAP, there were 109 (39%) deaths of 283 patients at day 90 with hydrocortisone plus fludrocortisone and 143 (51%) of 279 patients receiving placebo (odds ratio [OR] 0·60, 95% CI 0·43-0·83). In patients without CAP, there were 148 (46%) deaths of 319 patients at day 90 in the hydrocortisone and fludrocortisone group and 157 (48%) of 329 patients in the placebo group (OR 0·95, 95% CI 0·70-1·29). There was significant heterogeneity in corticosteroid effects on 90-day mortality across subgroups with CAP and without CAP (p=0·046 for both multiplicative and additive interaction tests; moderate credibility). Of 1241 patients included in the APROCCHSS trial, 648 (52%) had ARDS (328 in the placebo group and 320 in the corticosteroid group). There were 155 (48%) deaths of 320 patients at day 90 in the corticosteroid group and 186 (57%) of 328 patients in the placebo group. The OR for death at day 90 was 0·72 (95% CI 0·53-0·98) in patients with ARDS and 0·85 (0·61-1·20) in patients without ARDS (p=0·45 for multiplicative interaction and p=0·42 for additive interaction). The OR for observing at least one serious adverse event (corticosteroid group vs placebo) within 180 days post randomisation was 0·64 (95% CI 0·46-0·89) in the CAP subgroup and 1·02 (0·75-1·39) in the non-CAP subgroup (p=0·044 for multiplicative interaction and p=0·042 for additive interaction). In a pre-specified subgroup analysis of the APROCCHSS trial of patients with CAP and septic shock, hydrocortisone plus fludrocortisone reduced mortality as compared with placebo. Although a large proportion of patients with CAP also met criteria for ARDS, the subgroup analysis was underpowered to fully discriminate between ARDS and CAP modifying effects on mortality reduction with corticosteroids. There was no evidence of a significant treatment effect of corticosteroids in the non-CAP subgroup. Programme Hospitalier de Recherche Clinique of the French Ministry of Health, by Programme d'Investissements d'Avenir, France 2030, and IAHU-ANR-0004.

Racial differences in measures of glycemia in the Vitamin D and Type 2 Diabetes (D2d) Study: a secondary analysis of a randomized trial

IntroductionUnderstanding how race may influence the association between A1c and glycemia can improve diabetes screening. We sought to determine whether, for a given A1c level, glucose levels during an oral...

Protocolo diagnóstico del ardor y el dolor epigástrico crónico

Abdominal pain in the epigastrium is one of the most frequent causes of medical consultation. A medical history and physical examination will guide the diagnostic steps according to the suspected disease. The most frequent causes are functional dyspepsia, peptic ulcer disease, gastroesophageal reflux disease, or chronic pancreatitis. The most commonly used diagnostic methods are abdominal ultrasound and gastroscopy. In this protocol, a diagnostic algorithm is developed to guide additional tests based on clinical suspicion.

Neuropsychological profiles comparison between Multiple Sclerosis patients and Multiple Sclerosis patients with overlapping features of systemic lupus erythematosus

AimMultiple sclerosis (MS) and Systemic Lupus Erythematosus (SLE) are autoimmune disorders that may lead to cognitive impairment. This study aimed to compare the neuropsychological profiles of patients with MS, and MS and coexisting SLE features. MethodsWe included a total of 90 participants, divided into 3 groups: 30 patients with clinically definite relapsing remitting MS, 30 with coexisting MS and incomplete SLE (overlap group) and 30 healthy controls (HC). All participants underwent neuropsychological assessment with the Montreal Cognitive Assessment (MoCA), Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and Selective Reminding Test (SRT). ResultsBoth groups scored lower on the MoCA compared to the HC (p < .001). The overlap group showed the lowest performance on the SDMT and PASAT compared to the other two groups (p < .01), while the MS group scored similarly to the HC in the PASAT (p > .05). Regarding the learning rate and long-term recall, the overlap group had lower scores compared to both the MS and HC (p < .001), but it outperformed both groups in the retention efficacy score (p < .001). The MS group did not differ significantly from the HC in these memory domains (p > .05). ConclusionThe overlap group exhibited a broader range of impairments, including slower processing speed, decreased working memory, reduced learning rate, and long-term retrieval deficits. Their retention ability remained intact. The coexistence of MS with SLE pathology had additive impacts on cognitive function.

Confirmatory factor analysis of the Race-Based Traumatic Stress Symptom Scale in a sample of Asian American adults.

The present study examined the factor structure of the Race-Based Traumatic Stress Symptom Scale (RBTSSS) in a sample of Asian American adults. The sample (n = 403) comprised 78% women, ages 18-72 years, who were administered the RBTSSS in a survey. A first-order and second-order confirmatory factor analysis (CFA) were conducted. The RBTSSS demonstrated good internal consistency in the present study, Cronbach's αs = .78-.94. The first-order CFA revealed mixed model fit indices, χ²(1,253) = 3,431.52, p < .001, root mean square error of approximation (RMSEA) = .066, comparative fit index (CFI) = .875, Tucker-Lewis index (TLI) = .868. The second-order CFA revealed similar mixed findings, χ²(1,267) = 3,559.93, p < .001, RMSEA = .067, CFI = .869, TLI = .863. Findings demonstrated mixed support for the factor structure of the RBTSSS in a sample of Asian American adults. Future research may consider additional testing of the RBTSSS in Asian Americans and further exploring the construct of racial trauma in Asian Americans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Robust individual pig tracking

The locations of pigs in the group housing enable activity monitoring and improve animal welfare. Vision-based methods for tracking individual pigs are noninvasive but have low tracking accuracy owing to long-term pig occlusion. In this study, we developed a vision-based method that accurately tracked individual pigs in group housing. We prepared and labeled datasets taken from an actual pig farm, trained a faster region-based convolutional neural network to recognize pigs’ bodies and heads, and tracked individual pigs across video frames. To quantify the tracking performance, we compared the proposed method with the global optimization (GO) method with the cost function and the simple online and real-time tracking (SORT) method on four additional test datasets that we prepared, labeled, and made publicly available. The predictive model detects pigs’ bodies accurately, with F1-scores of 0.75 to 1.00, on the four test datasets. The proposed method achieves the largest multi-object tracking accuracy (MOTA) values at 0.75, 0.98, and 1.00 for three test datasets. In the remaining dataset, the proposed method has the second-highest MOTA of 0.73. The proposed tracking method is robust to long-term occlusion, outperforms the competitive baselines in most datasets, and has practical utility in helping to track individual pigs accurately.

Differentiation of COVID‐19 pneumonia from other lung diseases using CT radiomic features and machine learning: A large multicentric cohort study

AbstractTo derive and validate an effective machine learning and radiomics‐based model to differentiate COVID‐19 pneumonia from other lung diseases using a large multi‐centric dataset. In this retrospective study, we collected 19 private and five public datasets of chest CT images, accumulating to 26 307 images (15 148 COVID‐19; 9657 other lung diseases including non‐COVID‐19 pneumonia, lung cancer, pulmonary embolism; 1502 normal cases). We tested 96 machine learning‐based models by cross‐combining four feature selectors (FSs) and eight dimensionality reduction techniques with eight classifiers. We trained and evaluated our models using three different strategies: #1, the whole dataset (15 148 COVID‐19 and 11 159 other); #2, a new dataset after excluding healthy individuals and COVID‐19 patients who did not have RT‐PCR results (12 419 COVID‐19 and 8278 other); and #3 only non‐COVID‐19 pneumonia patients and a random sample of COVID‐19 patients (3000 COVID‐19 and 2582 others) to provide balanced classes. The best models were chosen by one‐standard‐deviation rule in 10‐fold cross‐validation and evaluated on the hold out test sets for reporting. In strategy#1, Relief FS combined with random forest (RF) classifier resulted in the highest performance (accuracy = 0.96, AUC = 0.99, sensitivity = 0.98, specificity = 0.94, PPV = 0.96, and NPV = 0.96). In strategy#2, Recursive Feature Elimination (RFE) FS and RF classifier combination resulted in the highest performance (accuracy = 0.97, AUC = 0.99, sensitivity = 0.98, specificity = 0.95, PPV = 0.96, NPV = 0.98). Finally, in strategy #3, the ANOVA FS and RF classifier combination resulted in the highest performance (accuracy = 0.94, AUC =0.98, sensitivity = 0.96, specificity = 0.93, PPV = 0.93, NPV = 0.96). Lung radiomic features combined with machine learning algorithms can enable the effective diagnosis of COVID‐19 pneumonia in CT images without the use of additional tests.

Promising Themes for Electronic Cigarette Prevention Campaigns for Youth and Young Adults.

Electronic cigarettes (e-cigarettes) are the most widely used tobacco product by youth and young adults in the United States. Effective prevention campaigns require the identification of appropriate content focus for message construction. A sample of 2622 youth and young adults ages 15-24 were recruited through social media advertisements and completed an online survey. Respondents reported current e-cigarette use or intention to use if not currently using. They also indicated agreement or disagreement with 75 e-cigarette-related beliefs representing 16 themes. The relative promise of each theme/belief for campaign messaging was investigated by examining its association with the behavior/intention outcomes and the opportunity for positive change in its distribution (room to move). All themes showed significant associations with the behavior (ORs = 2.49-19.04) and intention (ORs = 2.21-6.11) outcomes. Room to move for themes ranged from 32.9% to 96.3% in behavior analysis and 15.6-93.9% in intention analysis. A normed relative promise index (M = 50, SD = 17) showed flavors (72), comparison to cigarettes (69), and relaxation and mental health (68) as the top ranked themes. Subgroup analyses by demographics revealed few differences. Results on the belief level were largely consistent with those on the theme level. Data from this study provide timely evidence for the relative value of various themes/beliefs as potential targets for message development in e-cigarette prevention campaigns. The final selection of target themes/beliefs requires consideration of openness to persuasion, which may be informed by additional testing. Electronic cigarettes (e-cigarettes) are the most widely used tobacco products among youth and young adults in the United States. This study adds new evidence on the relative promise of a wide range of e-cigarette beliefs and belief clusters (themes) as potential targets for message development in educational campaigns. This evidence is important to consider in future campaign efforts directed at the youth and young adult populations in the United States.

Hepatitis C virus reinfection incidence among gay and bisexual men with HIV in Australia from 2016 to 2020.

There is some concern that hepatitis C virus (HCV) reinfection might impact HCV micro-elimination efforts among gay and bisexual men (GBM) with HIV. However, there is a limited understanding of reinfection incidence in the context of unrestricted government-funded HCV treatment. We aimed to estimate HCV reinfection incidence among GBM with HIV in Australia from 2016 to 2020. Data were from 39 clinics participating in ACCESS, a sentinel surveillance network for blood borne viruses and sexually transmissible infections across Australia. GBM with HIV who had evidence of treatment or spontaneous clearance with at least one positive HCV RNA test, a subsequent negative HCV RNA test, and at least one additional HCV RNA test between 1st January 2016 and 31st December 2020 were eligible for inclusion. A new HCV RNA positive test and/or detectable viral load was defined as a reinfection. Generalised linear modelling was used to examine trends in reinfection. Among 12 213 GBM with HIV who had at least one HCV test, 540 were included in the reinfection incidence analysis, of whom 38 (7%) had evidence of reinfection during the observation period. Over 1124 person-years of follow-up, the overall rate of reinfection was 3.4/100PY (95% CI 2.5-4.6). HCV reinfection incidence declined on average 30% per calendar year (Incidence Rate Ratio 0.70, 95% CI 0.54-0.91). HCV reinfection incidence has declined among GBM with HIV in Australia since government-funded unrestricted DAAs were made available. Ongoing HCV RNA testing following cure and prompt treatment for anyone newly diagnosed is warranted to sustain this.

Effects of Streptozotocin Induced Diabetes on One-Carbon Cycle and Sperm Function.

Diabetic men suffer an increased risk of infertility associated with signs of oxidative damage and decreased methylation in sperm pointing to a deficit of the one-carbon cycle (1CC). We aimed to investigate this deficit using mice models (type 1 and 2) of streptozotocin-induced diabetes. In this experimental study, 50 male mice, aged eight weeks, were divided randomly into four groups: sham, control, type 1 diabetes mellitus (DM1), and DM2. The DM1 group was fed a normal diet (ND) for eight weeks, followed by five consecutive days of intraperitoneal administration of Streptozotocin (STZ, 50 mg/kg body weight). The DM2 group was fed a high-fat diet (HFD) for eight weeks, followed by a single intraperitoneal injection of STZ (100 mg/kg). After twelve weeks, all the mice were euthanized, and study parameters assessed. In the sham group, citrate buffer as an STZ solvent was injected. Both types of diabetic animals had serious impairment of spermatogenesis backed by increased DNA damage (P=0.000) and decreased chromatin methylation (percent: P=0.019; intensity: P=0.001) and maturation (P=0.000). The 1CC was deeply disturbed with increased homocysteine (P=0.000) and decreased availability of carbon units [methionine (P=0.000), serine (P=0.088), folate (P=0.016), B12 (P=0.025)] to feed methylations. We have observed a distinct impairment of 1CC within the testes of individuals with diabetes. We speculate that this impairment may be linked to inadequate intracellular glucose and diminished carbon unit supply associated with diabetes. As a result, interventions focusing on enhancing glucose uptake into sperm cells and providing supplementary methyl donors have the potential to improve fertility issues in diabetic patients. However, additional clinical testing is required to validate these hypotheses.

Analysis of food inflation convergence in NUTSII regions of Türkiye

In this research, it is examined whether the increase in food inflation observed in Turkey in recent years due to global factors as well as the slowdown in food inflation convergence among regions. In this context, the research aims to analyze the food inflation convergence among NUTS II regions. Since it takes into account the effect of global shocks, tests that take structural break into account are used. In addition, first and second generation tests that do not take into account the structural break are also used and the all test findings are compared. The findings differ according to the consideration of horizontal cross-section dependence and structural break. In addition, the findings also vary according to the a priori determination of the structural break. According to the findings of the test taking into account the soft break, the existence of food inflation convergence among regions except TR83 region is found. The second generation test findings also support this result. In line with the findings, it is concluded that the increase in food inflation observed in Turkey in recent years is not due to the slowdown in food inflation convergence across regions.

Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

Wolf–Parkinson–White (WPW) syndrome is a disorder characterized by the presence of at least one accessory pathway (AP) that can predispose people to atrial/ventricular tachyarrhythmias and even sudden cardiac death. It is the second most common cause of paroxysmal supraventricular tachycardia in most parts of the world, affecting about 0.1–0.3% of the general population. Most patients with WPW syndrome have normal anatomy, but it may be associated with concomitant congenital heart disease or systemic diseases. Although many individuals are asymptomatic, during supraventricular arrhythmia episodes, they may experience severe symptoms, including syncope or even sudden cardiac death (mainly due to pre-excited atrial fibrillation over rapidly conducting AP). In addition to arrhythmia-related symptoms, for some specific locations of the APs with overt anterograde conduction, there might be a reduction in exercise capacity mediated by a reduction in LV systolic performance due to anomalous LV depolarization. Although it is typically diagnosed through electrocardiography (ECG), additional tests are necessary for risk assessment. Management of WPW syndrome may be quite challenging and can vary from only acknowledging the presence of the accessory pathway to pharmacological treatment or radiofrequency ablation. Early diagnosis, risk assessment, and appropriate treatment are critical steps in the management of WPW syndrome, aiming to improve the quality of life and reduce the risk of life-threatening arrhythmias.

Challenging Case: A Multidisciplinary Approach to Demystifying Chronic Sleep Impairment in an Infant with a Complex Medical and Behavioral Profile.

Challenging Case: A Multidisciplinary Approach to Demystifying Chronic Sleep Impairment in an Infant with a Complex Medical and Behavioral Profile.

High-Sensitivity Cardiac Troponin T to Exclude Cardiac Involvement in TTR Variant Carriers and ATTRv Amyloidosis Patients

(1) Background: Individuals carrying a pathogenic transthyretin gene variant (TTRv) are at high risk for developing hereditary transthyretin (ATTRv) amyloidosis and are routinely screened for the development of cardiomyopathy (ATTRv-CM). This study aims to evaluate whether the cardiac biomarkers N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) can be used to rule out ATTRv-CM. (2) Methods: In this retrospective case-control study, data from 46 ATTRv-CM patients and 101 TTRv carriers and ATTRv amyloidosis patients without cardiomyopathy were included. Binary logistic regression models were used to assess the ability of NT-proBNP and hs-cTnT to predict the diagnosis of ATTRv-CM. An optimal cutoff for the relevant biomarker(s) was determined based on a sensitivity of ≥99% and the highest possible percentage of additional tests avoided (%ATA) in the index dataset. (3) Results: Hs-cTnT demonstrated the highest predictive capabilities for ATTRv-CM. The addition of NT-proBNP did not improve the predictive model. A hs-cTnT cutoff of &lt;6 ng/L resulted in a 97% sensitivity and a negative predictive value of 95% with a %ATA of 30% in the validation dataset. (4) Conclusion: In conclusion, hs-cTnT is a useful biomarker for excluding cardiac involvement in TTRv carriers and ATTRv amyloidosis patients and it has the potential to prevent unnecessary diagnostic procedures.

The relevance of current forensic firearms examination techniques when applied to 3D printed firearms.

This research project had two major objectives. The first was to successfully print and fire the Liberator, a 3D-printed firearm, to assess its feasibility as a lethal weapon. The second objective was to identify any individual characteristics that might be deposited during the firing process by the firearm. The Liberator was printed using unchanged files downloaded from the internet using PLA and ABS filament. The Liberator was fired remotely into newspapers at the Allegheny County Medical Examiner's Office. The printing of the Liberator was both inexpensive and relatively quick with only minor hand modifications made after printing. The Liberator fractured beyond repair after firing but successfully fired and penetrated three newspapers. Neither the bullet nor the cartridge case exhibited any individual characteristics that could be used for identification purposes. Suspected thermoplastic deposits were identified on both the bullet and cartridge case, but additional testing must be done for confirmation purposes. In conclusion, the Liberator can be used reliably for one shot and will not yield any evidence for Firearms and Toolmark Examination.

Troponin testing in routine primary care: observations from a dynamic cohort study in the Amsterdam metropolitan area.

Troponin testing is indicated in the diagnostic work-up of acute coronary syndrome (ACS) and incorporated in risk stratification pathways. This study aims to gain insights on the use, outcomes, and diagnostic accuracy of troponin testing in routine primary care; a setting that is understudied. Routine data were used from the academic primary care network in the Amsterdam metropolitan area (968,433 patient records). The study population included adult patients who underwent high-sensitivity troponin I orT (hs-TnI/T) testing between 2011 and 2021. The primary outcome was the reported diagnosis and the secondary outcome was the diagnostic accuracy measured by death or ACS at 30days. 3,184 patients underwent hs-troponin testing, either with hsTNT (n=2,333) or hsTNI (n=851). Median patients' age was 55 (44-65) years, and 62.3 % were female. Predominant symptoms were chest pain and dyspnea (56.7 %). Additional diagnostic laboratory tests were commonly performed (CRP: 47.7 %, natriuretic peptides: 25.6 %, d-dimer: 21.5 %). Most common diagnoses were musculoskeletal symptoms (21.6 %) and coronary heart disease (7.1 %; 1.1 % ACS). Troponin testing showed sensitivity and specificity of 77.8 % (60.9-89.9) and94.3 % (93.5-95.1), respectively. Negative and positive predictive values were 99.7 (99.5-99.9) and 13.5 (11.1-16.4), andpositive and negative likelihood ratios were 13.7 (10.9-17.1) and 0.24 (0.13-0.43). GPs occasionally use troponin testing in very low-risk patients, often as part of a multi-marker rule-out strategy. The diagnostic characteristics of troponin tests, while promising, warrant prospective validation and implementation to facilitate appropriate use.

Paediatric orodispersible lozenges produced by moulding process: quality and stability control

Abstract Objectives Active pharmaceutical ingredients for paediatric patients are formulated at hospital pharmacy services and compounding pharmacies when they are not commercially available. This work evaluated the quality and stability of lozenges, an orodispersible dosage form, elaborated by a simple and low-cost moulding process. Methods The lozenges were formulated with 10 mg of hydrochlorothiazide as an active pharmaceutical ingredient and a commercial excipient suitable for paediatric use (Natatroche®). A High-Performance Liquid Chromatography system was used to quantify the active pharmaceutical ingredient from pure and extracted from dosage form samples. The quality of the lozenges was checked by the European Pharmacopeia tests indicated for oromucosal preparations, and additional quality tests specified for orodispersible and dispersible tablets. The stability of this dosage form was evaluated by the International Conference of Harmonization indications. Results The chromatographic method could quantify the active pharmaceutical ingredient extracted from excipient matrix. This formulation met uniformity of dosage units test for oromucosal dosage forms and, in addition, met the disintegration time test for orodispersible tablets and the fineness of dispersion test for dispersible tablets. Hydrochlorothiazide in lozenges was stable for 60 days when stored at 5 °C. Conclusions Moulded hydrochlorothiazide tablets are quick-to-prepare dosage forms that can be prepared in a simple, low-cost manufacturing process. They are safe and stable, disintegrate quickly in the mouth, and are therefore a recommended option for children, or other patients with swallowing problems.

Pore parameter selection for fused deposition modeling of gas diffusion layers in proton exchange membrane fuel cells

AbstractBecause of the global energy crisis, many researchers have focused their efforts on fuel cells. The gas diffusion layer (GDL) is a fundamental component of proton exchange membrane (PEM) fuel cells. The manufacturing procedures for traditional carbon‐based GDLs are sophisticated and energy‐intensive, and have design flexibility constraints, making it difficult to build complicated forms and structures. Additive manufacturing is widely used in a variety of fields, with the fused deposition modeling (FDM) technique being the most popular method. Prior to conducting systematic research on the printed GDLs, it is necessary to investigate the pore parameters with the support of FDM technique. In this research, the initial step involves material selection, FDM printer selection, and modeling. Subsequently, printing analysis and sample characterization are conducted to select an acceptable pore shape. A water drainage test determines the appropriate pore size, followed by additional tests for acceptable porosity range. The square pore shape is determined to be more suitable. A pore side length of 1.0 mm is identified. Furthermore, a suitable pore range of 10.9%–30.3% is identified. Next step, the printed GDLs will undergo further testing to investigate their suitability to be used in PEM fuel cells.

Exploring the Molecular Aspects of Myeloproliferative Neoplasms Associated with Unusual Site Vein Thrombosis: Review of the Literature and Latest Insights.

Myeloproliferative neoplasms (MPNs) are the leading causes of unusual site thrombosis, affecting nearly 40% of individuals with conditions like Budd-Chiari syndrome or portal vein thrombosis. Diagnosing MPNs in these cases is challenging because common indicators, such as spleen enlargement and elevated blood cell counts, can be obscured by portal hypertension or bleeding issues. Recent advancements in diagnostic tools have enhanced the accuracy of MPN diagnosis and classification. While bone marrow biopsies remain significant diagnostic criteria, molecular markers now play a pivotal role in both diagnosis and prognosis assessment. Hence, it is essential to initiate the diagnostic process for splanchnic vein thrombosis with a JAK2 V617F mutation screening, but a comprehensive approach is necessary. A multidisciplinary strategy is vital to accurately determine the specific subtype of MPNs, recommend additional tests, and propose the most effective treatment plan. Establishing specialized care pathways for patients with splanchnic vein thrombosis and underlying MPNs is crucial to tailor management approaches that reduce the risk of hematological outcomes and hepatic complications.

Beyond traditional therapies: clinical significance of complex molecular profiling in patients with advanced solid tumours-results from a Turkish multi-centre study.

The objective of this multi-centre, real-world study was to examine the potential influence of comprehensive molecular profiling on the development of treatment decisions or adjustments for patients with advanced solid malignancies. We then evaluated the impact of these informed choices on patient treatment outcomes. The study encompassed 234 adult patients (mean age: 52.7±14.3years, 54.7% women) who were diagnosed with solid tumours at 21 different medical centres in Turkey. Remarkably, 67.9% of the patients exhibited metastasis at the time of diagnosis. We utilized an OncoDNA (Gosselies, Belgium) platform (OncoDEEP) integrating next-generation sequencing with additional tests to harvest complex molecular profiling data. The results were analyzed in relation with two specific outcomes: (i) the impact on therapeutic decisions, including formulation or modifications, and (ii) associated treatment response. Out of the 228 patients with final molecular profiling results, 118 (50.4%) had their treatment modified, whilst the remaining 110 (47.0%) did not. The response rates were comparable, with 3.9 versus 3.4% for complete response, 13.6 versus 29.3% for partial response, 66.9 versus 51.7% for progressive disease and 15.5 versus 15.5% for stable disease for treatments informed and not informed by complex molecular profiling, respectively (P=0.16). Our real-world findings highlight the significant impact of complex molecular profiling on the treatment decisions made by oncologists for a substantial portion of patients with advanced solid tumours. Regrettably, no significant advantage was detected in terms of treatment response or disease control rates.