Clinical Management Research Articles

Court-ordered forensic psychiatry treatment in prison: determinants of outcome and risk mitigation

BackgroundCourt-ordered forensic psychiatry treatments (COT) are specifically designed to reduce the risk of violence in mentally disordered offenders. Given their high costs and ethical issues, mental health professionals need admission criteria to be able to select those candidates with optimal benefit. This study analyses offender-related and treatment-related determinants of COT outcome and risk mitigation.MethodsThis two-year longitudinal study assessed the evolution of 117 adult offenders admitted to a specialized medium-security forensic psychiatry clinic. Treatment outcome included court-ordered discharge locations and the Historical Clinical Risk Management (HCR) score evolution. Treatment progress was assessed every six months across five time-points including measures of protective factors, work rehabilitation and security. Outcome determinants included psychiatric diagnosis and type of offence.ResultsDischarge locations are predicted by pre-treatment risk level. Lower HCR scores are associated with discharge into low-security psychiatry wards independently of the psychiatric diagnosis. Risk reduction follows diagnosis-specific and offense-related patterns and reveals that mentally disordered offenders with Cluster B personality disorders or those sentenced for drug crimes are significantly less prone to benefit from COT.ConclusionsOur findings indicate that criminological characteristics at baseline as well as diagnosis of personality disorders are the main determinants of treatment outcome in our care setting. Inmates with concomitant higher violence risk at baseline and presence of Cluster B personality disorders might benefit the least from court-ordered forensic inpatient psychiatric care in prison.

Clinical features, pathophysiology, and management of acute myelopathy following CAR T-cell therapy.

Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of patients with relapsed or refractory hematologic malignancies, but it comes with unique toxicities, notably cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). As experience with CAR T-cell therapy grows, distinct and infrequent neurological complications are becoming increasingly evident. Recently, reports of acute myelopathy following the administration of CAR T-cell therapies have been accumulating. Despite the establishment of consensus guidelines for managing ICANS, there remains limited guidance on appropriate investigations and treatments for this rare complication. Here, we delve into the clinical features, pathophysiology, and strategies for optimally managing acute myelitis after CAR T-cell therapy, drawing insights from reported cases in the literature.

Laryngotracheal stenosis: a single-center retrospective analysis of endoscopic treatment strategies and recurrence

Background: Laryngotracheal stenosis is a process of fibrosis that results in airway obstruction; it may be congenital or acquired. Acquired cases are due to iatrogenic, traumatic, infectious and autoimmune causes. Patients present with a spectrum of breathing difficulties that might be fatal. Objectives: This article presents a unique retrospective cross-sectional study of patients with laryngotracheal stenosis who had endoscopic dilatation and some had open surgical procedures to describe the evolution after the therapy, to compare the outcomes of the dilatation in comparison to surgical interventions and associated complications in other studies, to provide knowledge to help in dealing with these patients, and to enable educated, independent patient decision-making. Material and methods: In this observational and descriptive study, we aimed to highlight the clinical features, management, and treatment outcomes among twenty-nine patients with laryngo-tracheal stenosis who were managed by open and endoscopic surgical intervention over a period of 5 years. Data was collected retrospectively from the patients’ medical records from February 2016 until July 2022 at ahospital in Jerusalem, which is a tertiary health care facility and the only referral center for similar cases from the West Bank, East Jerusalem, and Gaza, with a population of around 8 million. Tables and graphs are used to highlight the statistical study’s findings. Data was analyzed using Microsoft® Excel software. Results: Twenty-nine patients were involved in the study, with an average age of 32.2 years; 51.7% of them were males. The patients had one or more chronic conditions, such as hypertension and coronary artery disease. The majority of patients (65.5%) had stenosis as a result of orotracheal intubation, and the most common site was the subglottic (68.9%). According to the Cotton-Myer classification, 44.8% of the patients were classified in grade III, 34.4% were included in grade I, 13.7% in grade II, and 6.8% in grade IV. 6 patients (20.68%) received surgery for stenosis, and 23 patients had an endo-laryngeal dilatation. Re-stenosis happened in (58.6%). Mortality rates are almost negligible. Conclusion: Subglottic stenosis is still a challenging condition to manage. We describe a single-center experience approach dealing with these conditions. Long-term follow up for these cases is mandatory as the recurrence rate is still high.

Clinical Implications of HELLP Syndrome in Anesthesia Management of Preeclamptic Pregnant Mothers: A Literature-Based Review

BACKGROUND:Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a serious life-threatening obstetric emergency accompanied with heterogeneous presentation and multisystem dysfunction. It increases the perils of fetal morbidity and mortality and requires complex clinical management during medical and surgical interventions. Hence, it remains a major challenge for anesthesia providers during perioperative management. The current study aimed to explore the main clinical implications of HELLP syndrome in anesthesia management of preeclamptic pregnant mothers who underwent cesarean section.METHODOLOGY:An exhaustive search of the literature was conducted on the available relevant databases, such as PubMed, Google Scholar, and Cochrane Reviews, published from 1990 to 2023, using the terms HELLP syndrome, cesarean section, and anesthetic challenges/complications. All observational studies, randomized controlled trials (RCTs), cohorts, and nonrandomized studies on HELLP syndrome and anesthetic challenges during cesarean section reported in English were included. Nonpregnant mothers with HELLP syndrome and studies with no relevant reports or abstracts, case reports, or case studies were excluded.RESULTS:A systematic search of relevant databases identified 82 studies: 60 from PubMed, 18 from Google Scholar, and 4 from Cochrane Reviews. After removing duplicates, 48 studies were screened and recorded. Eighteen studies were assessed for eligibility after their titles and abstracts were reviewed. Twelve studies were excluded from the current study, as it did not fulfill the inclusion criteria. Finally, six studies, four retrospective studies, one prospective observational study, and one RCT, were included and reviewed.CONCLUSION:Perioperative anesthetic care in patients with HELLP syndrome remains a challenge. Hence, anesthetic techniques should be selected based on the severity of the condition, patient status, urgency surgery, fetal conditions, coagulation status, and safe platelet counts.

Distinctive features and prognostic utility of neutrophil in severe patients with Klebsiella pneumoniae infection

BackgroundNeutrophil plays a pivotal role in the management of Klebsiella pneumoniae infection. Delineate the clinical characteristics and prognostic utility of neutrophil in severe patients with K. pneumoniae infection are crucial for clinical management and prognostic assessment.MethodsK. pneumoniae patients with different infection sites were enrolled from Medical Information Mart for Intensive Care IV and eICU Collaborative Research Database. Temporal variations of neutrophil counts within 30 days of clinical onset were examined using locally weighted scatterplot smoothing curves. Logistic regression analysis was performed to assess the relationship between neutrophil counts and hospital mortality.ResultsA total of 1,705 patients caused by K. pneumonia were included in the study. The non-survivor group exhibited a comparatively older age and a higher proportion of K. pneumoniae infections originating from respiratory and bloodstream sources compared to the survivor group (38.4% vs 21.1%, p<0.0001, and 15.1% vs 10.3%, p=0.021). Patients combined with multiple drug resistance strains, respiratory infection, liver disease, and above 60 years exhibited a specific dynamic process of neutrophil levels. Neutrophils counts peaked at admission and 1-2 weeks later. There was a ‘U’-shaped relationship between neutrophil counts and hospital mortality.ConclusionsNeutrophils in K. pneumoniae infected patients have distinctive features and dynamic clinical trajectories. Close monitoring of severe patients infected with K. pneumoniae upon admission and during the first 1-2 weeks after admission is of utmost importance, particularly for patients with a neutrophil count exceeding 8.0×109/L.

DxGoals: A Software Tool for Determining and Analyzing Clinically Meaningful Classification Accuracy Goals for Diagnostic Tests.

To evaluate diagnostic tests for low prevalence conditions, classification accuracy metrics such as sensitivity, specificity, and positive likelihood ratio (PLR) and negative likelihood ratio (NLR) are advantageous because they are prevalence-independent and thus estimable in studies enriched for the condition. However, classification accuracy goals are often chosen without a clear understanding of whether they are clinically meaningful. Pennello (2021) proposed a risk stratification framework for determining classification accuracy goals. A software application is needed to determine the goals and provide data analysis. We introduce DxGoals, a freely available, R-Shiny software application for determining, visualizing, and analyzing classification accuracy goals for diagnostic tests. Given prevalence p for the target condition and specification that a test's positive and negative predictive values PPVand NPV=1-cNPV should satisfy PPV>PPV* and cNPV<cNPV*, DxGoals uses Bayes Theorem to determine equivalent goals for PLR and NLR and implied goals for sensitivity and specificity. When study data are provided, DxGoals analyzes whether the determined goals are met with statistical significance. When comparing 2 tests, DxGoals translates a superiority or noninferiority goals for the differences PPV-p and p-cNPV to equivalent goals for PLR and NLR and analyzes the goals when data are provided. We illustrate DxGoals on tests for penicillin allergy, ovarian cancer, and cervical cancer. The inputs cNPV*,p, and PPV* were informed by clinical management guidelines. DxGoals facilitates determination, visualization, and analysis of clinically meaningful standalone and comparative classification accuracy goals. It is a potentially useful tool for diagnostic test evaluation.

A Novel Next-Generation Sequencing Assay for the Identification of BCR::ABL1 Transcript Type and Accurate and Sensitive Detection of TKI-Resistant Mutations.

The clinical management of chronic myeloid leukemia (CML) patients requires the identification of the type of BCR::ABL1 transcript at diagnosis and the monitoring of its expression and potential tyrosine kinase inhibitor (TKI) resistance mutations during treatment. Detection of resistant mutation requires transcript type-specific amplification of BCR::ABL1 from RNA. In this study, a custom RNA-based next-generation sequencing (NGS) assay (Dup-Seq BCR::ABL1) that enables (a) the identification of BCR::ABL1 transcript type and (b) the detection of resistance mutations from common and atypical BCR::ABL1 transcript types was developed and validated. The assay design covers BCR exon 1 to ABL1 exon 10 and employs duplicate PCR amplification for error correction. The custom data analysis pipeline enables breakpoint determination and overlapped mutation calling from duplicates, which minimizes the low-level mutation artifacts. This study demonstrates that this novel assay achieves high accuracy (positive percent agreement (PPA) for fusion: 98.5%; PPA and negative percent agreement (NPA) for mutation at 97.8% and 100.0%, respectively) and sensitivity (limit of detection (LOD) for mutation detection at 3% from 10 000 copies of BCR::ABL1 input). The Dup-Seq BCR::ABL1 assay not only allows for the identification of BCR::ABL1 typical and atypical transcript types and accurate and sensitive detection of TKI-resistant mutations but also simplifies molecular testing work flow for the clinical management of CML patients.

Liver-related aspects of valoctocogene roxaparvovec gene therapy for hemophilia A: expert guidance for clinical practice.

Adeno-associated virus (AAV)-based gene therapy (valoctocogene roxaparvovec) is an attractive treatment for hemophilia A. Careful clinical management is required to minimize the risk of hepatotoxicity, including assessment of baseline liver condition to determine treatment eligibility and monitoring liver function after gene therapy. This article describes recommendations (developed by a group of hemophilia experts) on hepatic function monitoring before and after gene therapy. To prevent harmful liver-related effects, gene therapy is contraindicated in patients with uncontrolled liver infections, autoimmune hepatitis, liver stiffness ≥8 kPa or cirrhosis. Before using gene therapy in patients with liver steatosis or other liver disorders, the risk of liver damage should be considered using a highly individualized approach. Treatment is not recommended in patients with abnormal liver enzymes, including alanine aminotransferase (ALT) at any level above the upper limit of normal (ULN). Therefore, pre-treatment assessment of liver health should include laboratory tests, abdominal ultrasound and liver stiffness measurements by transient elastography (TE). In the first year after therapy, ALT levels should be monitored 1-2 times/week to detect elevations ≥1.5 × ULN, which may require immunosuppressant therapy. Patients with ALT elevation should receive prednisone 60 mg/day for 2 weeks, followed by stepwise tapering when ALT returns to baseline. ALT monitoring should continue long-term (every 3-6 months), along with abdominal ultrasound (every 6 months) and TE (yearly) evaluations. When patients with good liver health are selected for treatment and closely monitored thereafter, ALT elevations can be promptly treated and are expected to resolve without long-term hepatic sequelae.

Sub-optimal therapy of patients with primary biliary cholangitis (PBC) in the real-life stetting of the German PBC cohort.

Real-world data on the management of patients with primary biliary cholangitis (PBC) are so far scarce in Germany. Therefore, we aimed to establish a nationwide registry and describe the clinical characteristics and therapy of PBC patients.Three different cohorts defined as ursodeoxycholic acid (UDCA) responders, as inadequate responders according to Paris II criteria, and as newly diagnosed patients were prospectively recruited.This manuscript includes the baseline data of the project.In total, 33/77 (43%) contacted centres (58% of university hospitals, 38% of non-university hospitals, and 24% of private practices) recruited 515 patients including 204 UDCA responders, 221 inadequate responders to UDCA, and 90 newly diagnosed patients.All patients were treated with UDCA; however, a UDCA dosage below the recommended dosage of 13 mg/kg/d was observed in 38.5% of individuals after 12 months of treatment. UDCA dosages were lower in nonacademic compared to academic centres.Only 75/219 (38.5%) of inadequate responders to UDCA received a second-line therapy with obeticholic acid (OCA) and/or bezafibrate (BZF). OCA (13% vs. 4.5%) and BZF (14% vs. 6.5%) were significantly more often prescribed by academic vs. nonacademic centres.Pruritus (27% vs. 15.5%), fatigue (23% vs. 4.5%), and sicca syndrome (14% vs. 1%) were significantly more often reported by academic centres.The German PBC registry could be established, which indicates suboptimal therapy in a relevant proportion of patients and shows significant differences between academic and nonacademic centres. Results are fundamental to improving clinical management at different levels of care.

Intradermal Injection of a Thermoresponsive Polymeric Dexamethasone Prodrug (ProGel-Dex) Ameliorate Dermatitis in an Imiquimod (IMQ)-Induced Psoriasis-like Mouse Model.

Psoriasis is a chronic immune-mediated inflammatory skin disease, affecting ∼ 3% of the US population. Although multiple new systemic therapies have been introduced for the treatment of psoriatic skin disease, topical and intralesional glucocorticoids (GCs) continue to be used as effective psoriasis therapies. Their clinical utility, however, has been hampered by significant adverse effects, including skin atrophy and pigmentation as well as elevated blood glucose levels and hypertension. To mitigate these limitations, we have developed a N-(2-hydroxypropyl) methacrylamide (HPMA) copolymer-based thermoresponsive dexamethasone (Dex) prodrug (ProGel-Dex) and assessed its therapeutic efficacy and safety in an imiquimod (IMQ)-induced psoriasis-like (PL) mouse model. ProGel-Dex was intradermally administered once at three dosing levels: 0.5, 1.0, and 2.0 mg/kg/day Dex equivalent at the beginning of the study. PL mice were also treated with daily topical saline or Dex, which were used as control groups. Treatment of PL mice with ProGel-Dex dosed at 0.5 mg/kg/day resulted in a significant reduction in scaling and erythema. Improvement in gross pathology scores, skin histological scores, and serum cytokine levels was also observed. Interestingly, for mice treated with ProGel-Dex at 1.0 and 2.0 mg/kg/day Dex equivalent, only improvement in skin erythema was observed. GC-associated side effects, such as elevation of serum alanine aminotransferase (ALT) and amylase levels and body weight loss, were not observed in mice treated with ProGel-Dex at 0.5 and 1.0 mg/kg/day Dex equivalent. Collectively, these results demonstrate the efficacy and improved safety of ProGel-Dex in treating psoriatic skin lesions when compared to topical Dex treatment, supporting its translational potential for clinical management of lesional skin psoriasis.

Unravelling Migraine Stigma: A Comprehensive Review of Its Impact and Strategies for Change

Migraine-related stigma is a pervasive issue impacting nearly half of chronic migraine patients, with significant consequences for their quality of life, disability and mental health. Despite its profound effects, migraine stigma remains under-recognised in both clinical practice and research. This narrative review explores the three primary types of stigmas affecting migraine patients: public, structural and internalised. Public stigma involves negative societal attitudes and stereotypes that trivialise the condition. Structural stigma is reflected in policies that restrict access to necessary care and resources. Internalised stigma occurs when patients absorb these negative views, leading to self-blame and diminished self-worth. Addressing these different types of stigmas is crucial for improving the understanding, diagnosis and treatment of migraine. Educational efforts, advocacy and policy reform are essential strategies in this context. A deep understanding of stigma is vital for developing effective interventions that enhance clinical management and patient quality of life. Ultimately, reducing stigma can lead to better health outcomes and a more comprehensive approach to migraine care.

Clinical implication of sarcopenia in patients with acute decompensated heart failure: Design and rationale.

Sarcopenia is widely recognized as an age-related syndrome that involves a progressive loss of skeletal muscle mass and muscle strength. Many studies have shown that sarcopenia is associated with disease severity and exercise intolerance, as well as an independent predictor of mortality in patients with chronic heart failure. However, there is little research on the impact of sarcopenia on patients hospitalized with acute decompensated heart failure (ADHF). This is a prospective, multicentre, observational cohort study. Enrolment of at least 500 participants adults aged over 18years hospitalized for ADHF is planned, with a minimum of 195 cases each for patients with and without sarcopenia. Each patient is followed up for 6months, 1year, 2years or until the occurrence of endpoint. The primary clinical outcome is all-cause mortality at 6months. Other clinical outcomes of interest include cardiovascular mortality, all-cause hospitalization, heart failure hospitalization and survival time from enrolment to event occurrence. The sympathetic nervous activity, psychosocial factors, quality of life, physical function, and physical activity will be assessed and recorded at baseline. This study will examine the correlation between sarcopenia and prognosis in different subgroups of patients, and explore the additive effect of different comorbidities and sarcopenia on prognosis in patients with ADHF. This study will provide important information and evidence on the clinical aspects of sarcopenia in patients with ADHF, potentially contributing to accurate risk stratification and optimal clinical management for patients with ADHF. (URL: https://www. gov); Unique identifier: NCT06298825.

Investigating Ventriculoperitoneal Shunt Infections, Characteristics and Microbiology in Pediatric Patients with Hydrocephalus: A Single-Center Experience in Tehran, Iran

Background: This study investigates the epidemiology of ventriculoperitoneal (VP) shunt infections in pediatric patients with hydrocephalus, using data from 39 cases admitted to Loghman Hakim Hospital over a five-year period. Methods: This study was a case series involving a retrospective analysis of medical records, with a focus on demographic characteristics, etiological factors, and clinical outcomes. Statistical analyses were performed to explore associations between VP shunt infections and various variables. Results: The study identified a significant association between VP shunt infections and the presence of fever (P &lt; 0.05) as well as the number of white blood cells (WBCs) in cerebrospinal fluid (CSF) obtained from the VP shunt (P &lt; 0.01). This association may be explained by the release of cytokines during VP shunt infections, which can lead to the development of fever. Additionally, the stimulation of the immune system in response to the infection may cause an influx of WBCs into the CSF surrounding the VP shunt. Conclusions: This investigation offers valuable insights into the complex dynamics of VP shunt infections in pediatric patients with hydrocephalus. The observed associations between infection, fever, and WBC count enhance our understanding of the immunological responses triggered by VP shunt infections. These findings highlight the need for further research to elucidate these pathways, which could inform targeted interventions in the clinical management of VP shunt infections in pediatric populations.

Impact of targeted neonatal echocardiography consultations for critically sick preterm neonates

RationalePreterm neonates needing rescue treatments with inotropes and/or inhaled nitric oxide (iNO) (acute critical illnesses, ACIs) in neonatal intensive care units (NICUs) are at high risk of mortality. While targeted...

ADLM Guidance Document on the Measurement and Reporting of Lipids and Lipoproteins.

The accurate measurement of blood lipids and lipoproteins is crucial for the clinical management of atherosclerotic disease risk. Despite progress in standardization, there are still significant variations in pre-analytical requirements, methods, nomenclature, and reporting work flows. The guidance document aims to improve standardization of clinical lipid testing work flows. It provides recommendations for the components of the lipid panel, fasting requirements, reporting of results, and specific recommendations for non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein(a) [Lp(a)], apolipoprotein B (apo B), point-of-care lipid testing, and LDL subfraction testing. Lipid panels should always report non-HDL-C and LDL-C calculations if possible. Fasting is not routinely required except in specific cases. Modern equations should be utilized for LDL-C calculation. These equations allow for LDL-C reporting at elevated concentrations of triglycerides and obviate the need for direct measured LDL-C in most cases.

Specific persistent symptoms of COVID-19 and associations with reinfection: a community-based survey study in southern China

BackgroundSurveillance remains fundamental to understanding the changes in epidemiological patterns regarding post-COVID conditions and reinfections. Persistent symptoms and reinfection in previously infected individuals are increasing being reported in many countries, but their associations among general populations were seldomly reported. Understanding the association with persistent symptoms of COVID-19 reinfection is essential to develop strategies to mitigate the long-term health and socio-economic impacts of the post-COVID conditions. This study aimed to investigate the incidence of COVID-19 persistent symptoms among previously infected Chinese community residents and explore associations of specific COVID-19 persistent symptoms with reinfection and other factors.MethodsA community-based survey was conducted in a southern city of China with about 20 million residents from August 3 to 24, 2023. Face-to-face questionnaires were distributed to a total of 1,485 residents to collect their information about COVID-19 infection, reinfection, specific ongoing persistent symptoms, and other COVID-19 related information. Multivariable logistic regression analysis was used to examine the association between specific persistent symptoms and reinfection of COVID-19, along with age, gender, and educational level.ResultsOf the 1,485 participants, 1,089 (73.3%) reported they had been infected with COVID-19. Among them, 89.1% reported having ongoing persistent symptoms and 14.2% reported had two or more times of infection. About 20% participants were infected 1 year or more since their initial infection. Fatigue, cough, and headaches were the top 3 symptoms being reported. Participants with reinfection were associated with a higher probability of reporting headaches (OR: 1.54, 95% CI: 1.06–2.25), loss of or change in smell and/or taste (OR: 1.90, 95% CI: 1.27–2.83), impaired sleep (OR: 1.55, 95% CI: 1.02–2.35), and brain fog (OR: 1.76, 95% CI: 1.12–2.76). Participants aged 45 and above and who had a bachelor’s or higher degree were more likely to report chest tightness or shortness of breath, impaired sleep, and brain fog.DiscussionDuring the post-emergency period of COVID-19 pandemic, the incidence of ongoing persistent symptoms among Chinese residents remains high. Individuals whose initial infection was longer than 1 year have the highest probability of reporting having multiple symptoms. Reinfection may increase the risk of reporting headaches, loss of or change in smell and/or taste, impaired sleep, and brain fog. It is important to maintain routine syndromic surveillance among previously infected people and provide recommendations for clinical management of individuals with multiple ongoing symptoms.

Diagnostic accuracy of cytology and urine methylation test in patients with non-muscle invasive bladder cancer: a systematic review and meta-analysis

BackgroundMultiple clinical studies have demonstrated the numerous advantages of urine methylation test over cytology for monitoring patients with non-muscle invasive bladder cancer (NMIBC) following surgery. This research aims to provide a systematic review and meta-analysis to evaluate the efficacy and limits of urine methylation test in the clinical management of NMIBC.MethodsThis research was carried out by conducting a comprehensive search of clinical trials comparing cytology and urine methylation test for NMIBC follow-up using databases such as PubMed, Embase, Web of Science, and the Cochrane Library up until May 2023, including references from relevant articles. The study is registered on PROSPERO with ID CRD42023398969.ResultThis study comprised six studies with a total of 1676 patients. The analysis revealed that the AUC of urine methylation test had a greater AUC than that of the cytology examination (0.89 vs 0.71). In post-operative follow-up of patients with NMIBC, the urine methylation test demonstrated a significant sensitivity (0.69 vs 0.52), but with lower specificity (0.87 vs 0.93) than cytology examination.ConclusionThe urine methylation test and cytology examination have both shown strong diagnostic performance in screening for NMIBC patients. However, urine methylation test outperforms cytology examination in terms of accuracy and sensitivity.Systematic review registrationPROSPERO, identifier CRD42023398969.

Multicenter investigation of preoperative distinction between primary central nervous system lymphomas and glioblastomas through interpretable artificial intelligence models.

Research into the effectiveness and applicability of deep learning, radiomics, and their integrated models based on Magnetic Resonance Imaging (MRI) for preoperative differentiation between Primary Central Nervous System Lymphoma (PCNSL) and Glioblastoma (GBM), along with an exploration of the interpretability of these models. A retrospective analysis was performed on MRI images and clinical data from 261 patients across two medical centers. The data were split into a training set (n = 153, medical center 1) and an external test set (n = 108, medical center 2). Radiomic features were extracted using Pyradiomics to build the Radiomics Model. Deep learning networks, including the transformer-based MobileVIT Model and Convolutional Neural Networks (CNN) based ConvNeXt Model, were trained separately. By applying the "late fusion" theory, the radiomics model and deep learning model were fused to produce the optimal Max-Fusion Model. Additionally, Shapley Additive exPlanations (SHAP) and Grad-CAM were employed for interpretability analysis. In the external test set, the Radiomics Model achieved an Area under the receiver operating characteristic curve (AUC) of 0.86, the MobileVIT Model had an AUC of 0.91, the ConvNeXt Model demonstrated an AUC of 0.89, and the Max-Fusion Model showed an AUC of 0.92. The Delong test revealed a significant difference in AUC between the Max-Fusion Model and the Radiomics Model (P = 0.02). The Max-Fusion Model, combining different models, presents superior performance in distinguishing PCNSL and GBM, highlighting the effectiveness of model fusion for enhanced decision-making in medical applications. The preoperative non-invasive differentiation between PCNSL and GBM assists clinicians in selecting appropriate treatment regimens and clinical management strategies.

The Use of Simulation in Communication Sciences and Disorders: A Follow-Up Survey.

This study investigates changes in the prevalence and practice of simulation in communication sciences and disorders (CSD) education. It is a follow-up to a 2015 survey on the same topic. Given the changes in program certification standards and the impact of the COVID-19 pandemic on clinical education programs across the United States, re-examination of simulation in CSD is warranted. An online questionnaire was developed to survey university programs accredited by the Council on Academic Accreditation of the American Speech-Language-Hearing Association. University program directors and clinical directors received recruitment e-mails using QuestionPro, an online survey platform. The recruitment e-mail contained the purpose of the study and a link to the online questionnaire along with instructions to forward the survey to the appropriate designee. The consent form was then embedded in the questionnaire. The results of this survey indicated changes in patterns and the use of simulation in clinical education for CSD. Results indicated an overall increase in the use of simulations, specifically in computer-based simulations. Distance simulation as a hybrid technology proved a major addition to clinical education programs during the COVID-19 pandemic. External and internal factors affecting the use of simulations in CSD were identified. The use of simulation to supplement clinical education in CSD has evolved in recent years. These changes are likely due in part to changes in certification standards in the profession, an increase in awareness and training, and reliance on distance simulation during the COVID-19 pandemic.

Cardiogenic shock severity predicts bleeding events in patients with temporary mechanical circulatory support.

Data on shock severity and bleeding events in patients with temporary mechanical circulatory support (tMCS) are limited. We investigated the relationship between the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage classification and bleeding events in patients with tMCS. We evaluated the data of 285 consecutive patients with tMCS who were admitted to our institution between June 2019 and May 2022. At the time of tMCS initiation, 81 patients (28.4%) were in SCAI stage A, 38 (13.3%) in stage B, 69 (24.2%) in stage C, 33 (11.6%) in stage D, and 64 (22.5%) in stage E. Multivariable logistic regression modeling was used to assess the association between the SCAI shock stage and in-hospital bleeding events. In-hospital bleeding occurred in 100 patients (35.1%). The bleeding event rate increased incrementally across the SCAI shock stages (stage A, 11.1%; stage B, 15.8%; stage C, 37.7%; stage D, 54.6%; stage E, 64.1%). In-hospital bleeding was associated with the SCAI shock stage (p < 0.001). Compared with stage A, the adjusted odds ratios for in-hospital bleeding were 1.48 (95% confidence interval [CI] 0.47-4.66), 6.47 (95% CI 2.61-10.66), 11.59 (95% CI 3.77-35.64), and 7.85 (95% CI 2.51-24.55) for stages B, C, D, and E, respectively. The SCAI shock stage predicted subsequent bleeding events in patients with tMCS. This simple scheme may be useful for tailored risk-based clinical assessment and management of patients with tMCS.