Grading Criteria Research Articles

Exploring the antibacterial and anti-biofilm activity of two Iranian medical-grade kinds of honey on multidrug-resistant Pseudomonas aeruginosa.

Pseudomonas aeruginosa is a prominent multidrug-resistant and biofilm-forming bacteria. Mono-floral honey, enriched with a variety of biological compounds, can be categorized as medical-grade honey due to its notable pharmacological benefits. In this study, two types of Iranian honey were thoroughly characterized, and the antimicrobial and anti-biofilm properties were examined against three clinical strains of multidrug-resistant P. aeruginosa. Citrus and Thyme honey from Alborz were selected based on physicochemical, phytochemical, and melissopalynological tests conducted from a medical perspective. The antibacterial activity of the honey samples against three clinical strains of multidrug-resistant P. aeruginosa isolated from wound infections was evaluated using both the well-diffusion and broth microdilution methods. Additionally, an antibiofilm assay was performed using the crystal violet method in microplates. Both medical grade honey samples exhibited considerable antibacterial activity against the three P. aeruginosa isolates at 75-100% v/v concentrations with inhibition zones measuring between 15 and 30 mm. The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) values for both types of honey were 6.25% v/v (final concentration). The antibiofilm assay indicated that both types of honey demonstrated varying levels of antibiofilm activity. Citrus honey at 9% concentration was the most effective, showing an average inhibition rate of 59%, while Citrus honey at 2.3% final concentration exhibited the least effectiveness with an average inhibition rate of 23%. A thorough analysis of the honeys studied confirmed their authenticity and the presence of medicinal compounds. The results of honey tests correspond to the normal range (natural Honey) in the Council of the European Union. Based on the evaluation and compliance with the medical grade criteria including authenticity, health, qualities well botanical origin mentioned honey is classified in medical grade. The antibacterial results indicated that both Thyme and Citrus honeys effectively inhibit the growth and biofilm formation of P. aeruginosa. Therefore, these honeys may serve as natural and safe alternatives or adjuncts to conventional antibiotic therapy for wound healing and infection management.

Hospitalize or discharge the emergency department patient with syncope? A systematic review and meta-analysis of direct evidence for SAEM GRACE.

Syncope is a frequent reason for hospitalization from the emergency department (ED), but the benefit of hospitalization is unclear. This systematic review and meta-analysis (SRMA) aims to cohere and synthesize the best current evidence regarding the potential benefit of hospitalization for ED syncope patients for developing an evidence-based ED syncope management guideline. We conducted a SRMA according to the patient-intervention-control-outcome (PICO) framework: In patients 16 years of age or older who present to the ED with syncope (population), does hospitalization (intervention) or direct ED discharge (comparison) improve short-term outcomes (outcome)? The primary outcome was a composite of all adverse events as defined by individual studies, up to 30 days. Two reviewers independently assessed articles for inclusion and methodological quality. We measured heterogeneity among included studies with I-squared statistic and used GRADE criteria to assess the quality of evidence. Our search strategy identified 2140 publications and included 18 publications (510,545 participants) in the analysis. All studies reported higher rates of adverse events in hospitalized patients (0.7%-43.8%) compared to discharged patients (0%-3.7%). Our meta-analysis detected considerable statistical heterogeneity. The GRADE assessment for all adverse events and all-cause mortality revealed risk ratios of >5 favoring ED discharge for both outcomes at a median follow-up of 30 days. However, point estimates are limited by serious risk of bias, inconsistency, imprecision, indirectness, and publication bias. Due to the uncertainty of the available evidence, this SRMA's findings do not support a recommendation for or against hospitalizing patients presenting to ED with syncope. However, discharging low-risk patients with syncope from the ED is associated with a low risk of short-term adverse events.

Major approaches and scientific relevance of virtual surgery in implant dentistry: a systematic review

Introduction: Dental implant procedures have increased worldwide, reaching approximately one million dental implants per year the optimization of faster and more accurate techniques by dentists and postoperative surgeons with better results and quality of life stimulated the development of numerous software and hardware for performing computer-guided surgeries, the so-called Guided Surgeries (GS). Objective: The present study carried out a systematic review to highlight the optimization of the safety and effectiveness of digital dental implants. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out from June to July 2024 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 112 articles were found. A total of 42 articles were fully evaluated and 14 were included in the systematic review. A total of 32 studies were excluded because they did not meet the GRADE criteria, and 20 studies were excluded because they had a high risk of bias. Preoperative virtual planning and reconstruction of the mandible guided by dental implants through preoperative designs provide high success rates for the implant and dental rehabilitation, benefiting also prosthetic restorations supported by fixed implants. Still, the concept of using personalized implants with the help of 3D virtual treatment planning, stereolithographic models, and computer-assisted design greatly improves mandibular restoration and helps to obtain a good facial profile, and aesthetic and dental rehabilitation, avoiding complications with autologous grafts.

IDH-mutant astrocytomas with primitive neuronal component have a distinct methylation profile and a higher risk of leptomeningeal spread

IDH-mutant astrocytomas are diffuse gliomas that are defined by characteristic mutations in IDH1 or IDH2 and do not have complete 1p/19q co-deletion. The established grading criteria include histological features of brisk mitotic activity (grade 3) and necrosis and/or microvascular proliferation (grade 4). In addition, homozygous deletion of the CDKN2A/B locus has recently been implemented as a molecular marker for grade 4 IDH-mutant astrocytomas. Here, we describe a subgroup of high-grade IDH-mutant astrocytomas characterised by a primitive neuronal component based on histology and a distinct DNA methylation profile (n = 51, ASTRO PNC). Misinterpretation as carcinoma metastasis was common, since GFAP expression was absent in the primitive neuronal component, whereas TTF-1 expression was detected in 15/19 cases (79%) based on immunohistochemistry. Apart from mutations in IDH1, TP53, and ATRX, we observed enrichment for alterations in RB1 (n = 19/51, 37%) and MYCN (n = 14/51, 27%). Homozygous CDKN2A/B deletion (n = 1/51, 2%) and CDK4 amplification (n = 3/51, 6%) were relatively rare events. Clinical (n = 31 patients) and survival data (n = 23 patients) indicate a clinical behaviour similar to other CNS WHO grade 4 IDH-mutant astrocytomas, however with an increased risk for leptomeningeal (n = 7) and extra-axial (n = 2) spread. Taken together, ASTRO PNC is defined by a distinct molecular and histological appearance that can mimic metastatic disease and typically follows an aggressive clinical course.

Urban green spaces as regulators of thermal comfort for different age groups in the context of heat waves

ABSTRACT This study aims to bolster the resilience of cities in the face of heat wave disasters by considering climate regulation and residents’ thermal sensation. We chose a humid-hot climatic region for the experiment and used blend of objective climatic measurements and subjective questionnaires to analyze the thermal environment characteristics of different spatial forms of green spaces and the thermal sensation of people from different socio-demographic groups. The results demonstrate that (1) waterfront vegetation (semi-enclosed spaces) and mixed vegetation area (semi-open spaces) are the most effective in regulating urban microclimate effects and improving subjective thermal experience, (2) the subjective thermal sensation ranges reported by individuals consistently exceed the corresponding grading criteria under high heat pressure defined by the Wet Bulb Globe Temperature (WBGT), and (3) both elders (>65 years old) and children (<14 years old) exhibit weaker thermal sensitivity and a gentler response to temperature changes than people in other age groups. These results imply that green spaces with different structures and compositions have different effects on people’s thermal perception and people from different age groups respond heat waves differently. Consequently, it is necessary to implement real-time temperature monitoring in areas where these individuals gather, and to strengthen the early warning systems and guidance for their outdoor activities. These findings provide a reference for optimizing urban spatial forms and developing integrated ‘Heat-Health Action Plan’ in humid-hot regions around the world.

Effects of digital-based interventions on the outcomes of the eligibility criteria for sarcopenia in healthy older adults: A systematic review and meta-analysis.

While the digital-based interventions targeting older adults to prevent age-related health problems such as sarcopenia have grown rapidly in recent years, there are no meta-analyses indicating synthesized pooled estimates. To examine the effects of digital-based interventions on sarcopenia-related measures, including physical performance and muscle mass, in healthy community-dwelling older adults. Systematic searches were performed on MEDLINE, Web of Science, and Cochrane Library for eligible studies published up to 31 March 2023. The mean difference with a 95 % confidence interval was calculated. Methodological quality was assessed using Cochrane RoB 2.0. The GRADE criteria were used to assess evidence certainty. Thirteen randomized controlled trials with 742 participants were included in the meta-analysis. Handgrip strength, usual walking speed, five times sit-to-stand performance, and 30-second chair stand test showed significant enhancements with the digital-based interventions. However, there were no significant effects of digital-based interventions in appendicular muscle mass. The overall evidence certainty was low. Although digital-based interventions for healthy older adults are effective in improving physical functions, evidence certainty is low. Additional randomized controlled trials are thus required to further validate the findings.

Early management of acute caustic ingestion in pediatrics.

This review is intended to provide an overview of currently available literature related to caustic ingestion in pediatric patients, including initial management considerations in symptomatic versus asymptomatic children, timing and necessity of endoscopic evaluations, and the use of various therapeutic interventions. Further, this review provides management considerations for children presenting for evaluation following caustic ingestion based on the best available evidence. Additional research is needed to develop conclusive pediatric guidelines that meet GRADE criteria for management of caustic ingestion in children.

ABCA4 Deep Intronic Variants Contributed to Nearly Half of Unsolved Stargardt Cases With a Milder Phenotype.

The purpose of this study was to investigate the contribution and natural progression of ABCA4 deep intronic variants (DIVs) among a Chinese Stargardt disease (STGD) cohort. For unsolved STGD probands, DIVs in ABCA4 were detected by next-generation sequencing, and splicing effects were evaluated by in silico tools and validated through minigene experiments. Comprehensive ocular examinations, especially fundus changes, were carried out and analyzed. These and long-term follow-up data were compared with data of patients carrying biallelic coding variants of ABCA4. Seven DIVs in ABCA4 were identified in 18 of 40 (45.0%) unsolved STGD probands, involving 2 novel and 5 known variants. Four DIVs were confirmed to effect splicing through minigene assay. The c.161-395G>A was the most prevalent DIV allele (30.6%, 11/36). In the early 5-year duration, localized maculopathy was predominant, accounting for 51.9% (14/27) of fundus recordings. Expanded macular lesion within the vascular arch, with or without flecks, was observed in 75.0% (12/16) of recordings beyond the 5-year duration, whereas generalized retinal dystrophy was rarely observed. Compared with those in the non-DIV group, the patients in the DIV group manifested milder fundus change at all disease stages (P < 0.05). Follow-up visits utilizing wide-field fundus autofluorescence (FAF) further validated the slower development of lesions. Optical coherence tomography angiography (OCTA) documented a gradual reduction in perfusion in each layer's capillaries and high-reflective deposits below the sub-RPE layer. DIVs contribute to nearly half of STGD cases with missing heritability, totally occupying 7.8% of all STGD families. Based on optimized grading criteria, patients with DIV alleles manifested localized macular lesions with slow progress. The amount of residual correctly spliced mRNA might play a role, suggesting that adding or enhancing normal ABCA4 expression might be a potential approach of intervention.

Orthodontic Management of Different Stages and Grades of Periodontitis According to the 2017 Classification of Periodontal Diseases

Background/Objectives: The 2017 Periodontal Classification offers a comprehensive framework for the diagnosis and management of periodontitis based on staging and grading criteria. Orthodontic therapy is increasingly incorporated into the management of periodontitis to rectify malocclusion, pathological tooth migration, and occlusal stability. Nonetheless, few data directly correspond with this revised classification scheme. The objective of this systematic review is to figure out the influence of orthodontic therapy on periodontal outcomes in patients with Stage III and IV periodontitis, as categorized by the 2017 framework. Methods: A systematic review was performed in accordance with the PRISMA 2020 principles. The databases examined were PubMed, Web of Science, Scopus, and Google Scholar. The evaluation focuses on research published from 2012 to 2024. Seventeen studies were assessed after the application of the inclusion criteria. Key outcomes included clinical attachment level (CAL) improvement, probing depth (PD) decrease, and radiographic bone fill. Results: The integration of orthodontic treatment with periodontal therapy markedly enhanced CAL (mean gain: 4.35–5.96 mm), decreased PD (mean reduction: 3.1–6.3 mm), and facilitated radiographic bone regeneration (mean vertical fill: 4.89 mm). Patients with Stage IV Grade C periodontitis had the most significant improvement, especially with early orthodontic intervention subsequent to regenerative treatment. Prolonged follow-ups (up to 10 years) validated consistent results. Conclusions: Orthodontic intervention, as a supplementary measure to periodontal therapy, improves results in severe periodontitis, especially in Stage III and IV patients. These results underscore the need for multidisciplinary teamwork and defined protocols for including orthodontics in periodontitis therapy.

Interobserver agreement and practice patterns for grading of colorectal carcinoma: World Health Organization (WHO) classification of tumours 5th edition versus American Joint Committee on Cancer (AJCC) 8th edition staging manual.

The current American Joint Committee on Cancer (AJCC) staging manual and the College of American Pathologists (CAP) colorectal carcinoma (CRC) protocol specify use of a four-tiered grading system (i.e. grades 1-4; well-differentiated-undifferentiated) for CRC, based on percentage of gland formation. The World Health Organization (WHO) 5th edition grades CRC into low-grade (well- and moderately differentiated) and high-grade (poorly and undifferentiated), based on the least differentiated component. We studied interobserver agreement and practice patterns among pathologists when grading CRC by these two grading systems. Five gastrointestinal pathologists reviewed 100 scanned CRC slides and graded the tumour on each slide, per provided criteria in (a) WHO 5th edition book, (b) AJCC manual/CAP CRC protocol and (c) their clinical practice. A questionnaire for grading selected CRC subtypes was also provided. Statistical analysis was performed using Pearson's χ2 test and Fleiss multi-rater kappa analyses. Overall, agreement among the five reviewers when grading via WHO and AJCC criteria for low-grade and high-grade CRC was moderate (κ = 0.568, P < 0.001) and good (κ = 0.611, P < 0.001), respectively. All reviewers graded significantly more tumours as high-grade when using WHO (median = 46) versus AJCC/CAP criteria (median = 20). Interobserver agreement was higher using the AJCC grading criteria as a two-tiered system. Significantly more tumours were called high-grade using the WHO criteria. This raises concerns regarding upgrading tumours, as well as potential differences in grading tumours among pathologists worldwide, based on regional preferred grading systems. Synchronisation of these two grading systems is necessary for uniform grading of CRCs throughout institutions.

Sensitivity and specificity of the Tokyo Guidelines 2018 for acute cholecystitis diagnosis using different imaging modalities: ultrasonography or computed tomography

Background: Acute cholecystitis diagnosis is crucial in emergency room patients with upper right quadrant pain, however, there is little unanimity regarding the diagnosis. The Tokyo Guidelines 2018 (TG18) examine diagnostic, grading, and severity criteria for acute cholecystitis based on the consensus reached by global experts during talks at the Tokyo Consensus Meeting. However, the imaging modalities utilized by TG18 for diagnosis can impact the precision of this tool. The aim of this study was to evaluate the sensitivity and specificity of TG18 using different imaging modalities (ultrasonography or computed tomography). Methods: This prospective study recruited patients with a suspected history of acute cholecystitis who were admitted to the emergency department of a secondary hospital between December 2021 and August 2022. The acute cholecystitis was analyzed through the use of TG18 diagnosis (imaging modality = ultrasonography), TG18 diagnosis (imaging modality = computed tomography), and histopathology analysis. Results: 46 people were included. Using ultrasonography as an imaging modality, TG18 showed a decreased specificity (0.36) if compared to computed tomography (0.86). The sensitivity of TG18 was comparable to that of ultrasonography (1.00), as well as computed tomography (0.89). Utrasonography revealed a greater number of false positives, which dropped after the adoption of computed tomography as an imaging modality. Conclusions: The use of TG18 for the diagnosis of acute cholecystitis using computed tomography led to better identification of individuals with acute cholecystitis, with ultrasonography having a lower specificity if compared to computed tomography. They showed similar sensitivity, though.

The Correlation Between Meibomian Gland Dysfunction and Aniridia-Associated Keratopathy: A Prospective Analysis

Background/Objectives: Aniridia is a rare congenital disorder characterized by structural and functional abnormalities in ocular development due to PAX6 haploinsufficiency, leading to complications such as aniridia-associated keratopathy (AAK). Meibomian gland dysfunction (MGD), a prevalent yet underexplored condition in aniridia, exacerbates tear film instability and chronic ocular surface inflammation, contributing to AAK progression. This study investigates the relationship between MGD severity and AAK in individuals with aniridia. Methods: This prospective randomized study included 113 participants (53 with aniridia and 60 controls). Comprehensive ophthalmic evaluations, including noninvasive meibography, were performed. The MGD severity was assessed using a standardized meiboscore scale, while the AAK severity was classified according to established clinical grading criteria. Statistical analyses, including Spearman’s correlation and chi-squared tests, were used to evaluate the relationships among MGD, AAK, and visual acuity. Results: MGD was significantly more prevalent and severe in the aniridia group compared to controls (p &lt; 0.00001). A strong positive correlation was observed between MGD severity and AAK grade (r = 0.72, p &lt; 0.00001), with both conditions associated with reduced best-corrected visual acuity (BCVA; r = −0.80 and −0.86, respectively, p &lt; 0.0001). Age was positively correlated with MGD (r = 0.47, p = 0.0004) and AAK (r = 0.34, p = 0.0123), with gender-specific trends observed in females. Conclusions: MGD significantly contributes to AAK progression and visual impairment in aniridia. Meibography offers valuable insights into MGD severity, supporting early diagnosis and targeted interventions. Addressing MGD through tailored therapies could mitigate AAK progression and improve visual outcomes in this challenging condition.

Utilizing Collaborative Video Projects in Interpreter Training: English-majored Students’ Perceptions and Experiences

Based on a number of research papers about language education, student-produced video projects are beneficial and practical to improve language skills outside the classroom. Nevertheless, the use of this method in interpretation courses has yet to be widely studied in the world. Accordingly, the researchers utilized the experimental method in an interpretation course. The course had 40 seniors majoring in English for Tourism, asked to work in groups of four or five to plan and make their own video projects to practice interpreting in real-life contexts. Also, their video projects were graded as mid-term tests according to grading criteria. Quantitative and qualitative approaches were used to explore students’ perceptions and experiences of collaborative video projects. At the end of the course, they were invited to fill in surveys to discover their perceptions and what they could improve through this method. Furthermore, 12 of them joined online interviews to share their experiences as well as views of video projects. Based on the findings, most of the participants described collaborative video projects as new and motivating learning experiences helping develop their interpreting skills instead of studying in traditional classrooms. It was suggested that video projects should be used as a new teaching model in interpreter training.

Grading scales for vitreous haze

Background: Grading scales for vitreous haze are crucial for the diagnosis, monitoring, and management of uveitis. The presence of inflammatory cells within the vitreous cavity is widely recognized as a key indicator of disease activity and severity, offering valuable insights into the underlying inflammatory processes. This mini-review aims to explore the evolution of vitreous haze grading scales systematically, emphasizing conventional grading methods, advances in imaging technologies, and the integration of artificial intelligence (AI) into the grading process. Methods: The PubMed/MEDLINE database was comprehensively searched for studies published between 1959 and 2024, using keywords such as “AI-based grading systems,” “artificial intelligence,” “automated grading,” “grading scales for vitreous cells,” “inflammation,” “uveitis,” and “vitreous haze.” Relevant studies were identified, and additional articles were selected by reviewing the reference lists of the included publications. The selection of articles for inclusion in the mini-review was limited to those written in English. Results: In the current literature, two grading methods are used: the National Institutes of Health (NIH) scale and the Miami scale. Despite their widespread utilization, both scales entail subjective assessments of vitreous haze, which renders them susceptible to observer bias and interobserver variability. The NIH scale uses six levels, while the Miami scale employs nine levels, both of which require subjective assessments of vitreous haze. Recent advances in objective imaging technologies, namely ultrawide-field fundus photography and advanced optical coherence tomography-based analysis, have given rise to increasingly consistent and standardized grading systems, which may enhance the reliability of these assessments. Innovative techniques have been developed to enhance accuracy and sensitivity, thereby facilitating the early detection and precise monitoring of vitreous inflammation. Despite these advances, challenges remain, including the difficulty of distinguishing subtle variations in vitreous haze and the variability of inflammatory presentations. The incorporation of AI-driven tools and state-of-the-art imaging technologies into the vitreous cell grading signifies a substantial advance in the evaluation and management of uveitis. Conclusions: The development of more objective, reproducible, and quantitative grading scales is imperative for optimizing uveitis evaluation and grading vitreous haze in clinical settings and clinical trials. These innovations will also provide robust endpoints for clinical studies, ultimately improving patient care. Moreover, objective grading criteria will enhance diagnostic precision, facilitate better management of ocular inflammatory diseases, and promote further advances in uveitis research and treatment.

Ultrasound and single-port laparoscopic-guided microwave ablation of abdominal wall endometriosis lesions: Asingle-center observational study.

Raising the temperature of abdominal wall endometriosis lesions contributes to an effective ablation; however, providing sufficient protection to the surrounding tissues remains a challenge. In this study, we aimed to combine ultrasound and single-port laparoscopic images to not only achieve complete ablation of abdominal wall endometriosis lesions but also protect surrounding tissues from damage. The adverse events and complications were Common Terminology Criteria for Adverse Events grade 1 or Society of Interventional Radiology classification grade A. This historical study included 30 patients with abdominal wall endometriosis who underwent ultrasound and single-port laparoscopic-guided microwave ablation at the Ultrasonography and Gynecology Department of the Wuhan Central Hospital between October 2017 and February 2022. Ultrasonography and magnetic resonance imaging were used to evaluate the number, size, and depth of the lesions. Pain levels were assessed using a visual analog scale. Subsequently, ultrasound and single-port laparoscopic-guided microwave ablation of the lesions was performed, and patients were followed up to monitor the lesion volume and pain. One patient experienced an intra-abdominal wall burn that was detected by single-port laparoscopy, and ablation was stopped immediately. No other complications were recorded. Following surgery, the lesion volume decreased and was lower than the preoperative lesion volume at 1 year postoperatively (1.6 ± 1.3 vs. 4.0 ± 3.6 cm3; p < 0.05). Visual analog scale scores revealed that, compared with preoperative levels, pain was reduced significantly at all postoperative time points (p < 0.01). The recurrence rate was 16.7% (5/30). The addition of single-port laparoscopy to ultrasound-guided microwave ablation may allow greater protection of the surrounding tissues, particularly in cases involving deep lesions, and may, therefore, represent a promising clinical treatment strategy.

P0292 CD8+ Cell Dominance in Immune Checkpoint Inhibitor-Induced Colitis and Its Heterogeneity Across Endoscopic Features

Abstract Background Immune checkpoint inhibitor (ICI)-induced colitis is one of the major immune-related adverse events associated with ICI therapy, and it is known to be related to increased cytotoxic T cell (Tc) activity.1,2 ICI-induced colitis can be classified into Crohn’s disease (CD)-like, ulcerative colitis (UC)-like, and microscopic colitis (MC)-like patterns based on their endoscopic appearance.3 We aimed to compare T cell subsets based on the endoscopic features of ICI-induced colitis and to compare these findings with inflammatory bowel disease (IBD). Methods We analysed patients with ICI-induced colitis, confirmed through both endoscopic and histological evaluation. Biopsy specimens were examined using multiplex immunohistochemistry to assess their immune cell profile. Clinical outcomes of were analysed, and the immune cell profiles were compared based on their endoscopic features and further contrasted with those of IBD patients. Results Seventeen patients with ICI-induced colitis were included in the study. Most of these patients presented with common terminology criteria for adverse events grade 2 or higher adverse events, specifically diarrhoea (14/17, 82.4%) and colitis (12/17, 70.6%). Eleven patients (64.7%) received oral or intravenous steroid therapy (excluding beclomethasone), while six patients (35.3%) were prescribed beclomethasone. All patients showed clinical improvement after treatment. (Table 1) Based on endoscopic features, the patients were classified as CD-like (n=3, 17.6%), UC-like (n=9, 52.9%), and MC-like (n=5, 29.4%). In ICI-induced colitis, Tc was dominant over helper T cells (Th) (p=0.053), and this dominance was statistically significant in MC-like subgroup (p=0.020). On the contrary, IBD showed Th dominance(p=0.077). The number of intraepithelial CD8+ cells within the field were significantly higher in the MC-like group compared to the CD-like group (p=0.016), and similarly elevated in the UC-like group compared to the CD-like group (p=0.008). When comparing the number of intraepithelial CD8+ cells infiltrating the crypts, MC-like and UC-like subtypes had significantly more infiltrating cells than the CD-like subtype (p=0.016 and p=0.008, respectively) (Figure 1). Conclusion Analysis of T cell subsets of ICI-induced colitis patients revealed Tc dominant profile, contrasting with the Th dominance of IBD patients. Tc dominant profile was evident in UC-like and MC-like subtypes with marked crypt infiltration by CD8+ cells, suggesting a role for Tc in the pathophysiology of ICI-induced colitis.

Quantitative Review of Critical Plane Criteria and Stress Analysis Approaches for Multiaxial Fatigue of Welded Joints

ABSTRACTThis quantitative review evaluates the effectiveness of stress‐based critical plane criteria, specifically Findley's criterion, the approach due to Carpinteri–Spagnoli (CS), and the Modified Wöhler Curve Method (MWCM), in assessing fatigue strength in aluminum and steel welded joints subjected to constant amplitude (CA) and variable amplitude (VA) multiaxial loading. These criteria were analyzed alongside stress analysis approaches, including nominal stress (NS), hot‐spot stress (HSS), effective notch stress (ENS), and the Theory of Critical Distances–Point Method (TCD PM). Results confirm that all criteria effectively estimate fatigue life for steel welded joints under CA loading, with MWCM combined with HSS proving most accurate. For aluminum joints, estimations showed greater conservatism and scatter, highlighting the need for further experimental data to improve accuracy. Experimentally calibrated constants significantly enhanced prediction reliability. Future research should refine these criteria for diverse aluminum grades and thicknesses, ensuring accurate estimations and robust alternatives to established codes.

Australian Trachoma Surveillance Report update: 2014-2022.

Australia is the only high-income country where trachoma has been endemic, defined as an overall trachoma prevalence in Aboriginal and Torres Strait Islander children aged 5-9 years of 5% or more. The Australian Government funds the National Trachoma Surveillance and Reporting Unit to collate and analyse trachoma prevalence data and control strategies annually. This report presents data submitted from 2014 to 2022. In 2022, there were 87 remote communities considered at-risk of endemic trachoma, a decline of 51% since 2014 when 177 communities were considered at-risk. World Health Organization grading criteria are used to diagnose trachoma in at-risk populations. Overall prevalence, which includes estimates from all communities ever considered at-risk, fell below 5% endemicity thresholds for the first time in 2022 in Western Australia (2.9%), the Northern Territory (2.1%), New South Wales (0.5%), and in Queensland and South Australia (0.0% each). New cases of trachomatous trichiasis-a severe consequence of trachoma that causes blindness-were detected in eight out of 10,806 persons, aged 15 years and over, screened in 2022. Jurisdictional trichiasis prevalence was 0.2% in Western and South Australia and 0.0% in the Northern Territory. Australia must maintain overall trachoma and trichiasis prevalence below endemicity levels for a further two years before applying for World Health Organization validation of elimination of trachoma as a public health problem.

Noncryopexy versus cryopexy treatment during scleral buckling: a systematic review and meta-analysis.

To evaluate the differences in surgical outcomes between scleral buckling (SB) with noncryopexy and cryopexy methods. We systematically searched the Embase, Medline, Cochrane Library, and Scopus databases for randomized controlled trials (RCTs) published from their inception until January 1, 2024. A random-effects model was applied, and outcomes are presented as risk ratios (RRs) or standardized mean differences with 95% confidence intervals (CIs). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria. We included seven RCTs involving a total of 1103 patients. The meta-analysis revealed comparable retinal reattachment rates between noncryopexy and cryopexy methods (RR: 1.00; 95% CI: 0.96-1.05). Our subgroup analysis revealed similar results between nonretinopexy and laser retinopexy subgroups. Moreover, postoperative visual acuity (VA) and complication rates were comparable between noncryopexy and cryopexy methods (proportion of eyes with postoperative VA of 20/40 or better: RR: 1.24, 95% CI: 0.83-1.85; macular pucker: RR: 1.08, 95% CI: 0.53-2.21; cystoid macular oedema: RR: 1.01, 95% CI: 0.79-1.30; and subretinal pigmentary migration: RR: 0.34, 95% CI: 0.08-1.38). However, the certainty of evidence for these outcomes was low to very low, indicating the need for cautious interpretation of these findings. Similar surgical outcomes were noted between noncryopexy and cryopexy methods in SB, suggesting that both methods are effective in repairing rhegmatogenous retinal detachment. However, future studies on a larger scale and with longer follow-ups may be necessary to detect late redetachment and complications.

Thrombolysis for aneurysmal subarachnoid haemorrhage.

Aneurysmal subarachnoid haemorrhage continues to cause a significant burden of morbidity and mortality despite advances in care. Trials investigating local administration of thrombolytics have reported promising results. - To assess the effect of thrombolysis on improving functional outcome and case fatality following aneurysmal subarachnoid haemorrhage - To determine the effect of thrombolysis on the risk of cerebral artery vasospasm, delayed cerebral ischaemia, and hydrocephalus following subarachnoid haemorrhage - To determine the risk of complications of local thrombolysis in aneurysmal subarachnoid haemorrhage SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (last searched 9 March 2023), MEDLINE Ovid (1946 to 9 March 2023), and Embase Ovid (1974 to 9 March 2023). We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). We performed forward and reverse citation tracking of included studies using Google Scholar. We included randomised controlled trials comparing subarachnoid thrombolysis via any route of administration into any anatomical site continuous with the subarachnoid space versus placebo, sham thrombolysis, or standard treatment. Two review authors independently selected studies for inclusion in the review. We extracted study data and used version 2 of the Cochrane risk-of-bias tool for randomised trials to assess the risk of bias in the studies. We resolved any disagreement through discussion with a third author. Our primary outcome was poor functional outcome. Secondary outcomes were case fatality, haemorrhagic complications, cerebral artery vasospasm, delayed cerebral ischaemia, cerebral infarction, and hydrocephalus. We performed meta-analyses for each outcome and performed sensitivity analysis excluding studies at high risk of bias. We presented results as risk ratios (RRs) with 95% confidence intervals (CIs). We performed further sensitivity analysis by including all intervention groups from studies reporting more than one intervention group. For each outcome, we used the GRADE criteria to determine the certainty of the evidence. We included eight studies from six countries in this review. The studies had a total of 410 participants, of whom 205 received thrombolysis. We identified three ongoing trials. We assessed one trial as having a high risk of bias for all outcomes; we assessed the remainder as having a low risk of bias or some concerns. Thrombolysis likely results in a reduction in poor functional outcome when compared to placebo or standard care (29.4% versus 39.7%, RR 0.73, 95% CI 0.56 to 0.94; 8 studies, 408 participants; moderate-certainty evidence). Thrombolysis likely results in little to no difference in case fatality (12.8% versus 17.7%, RR 0.71, 95% CI 0.46 to 1.10; 8 studies, 408 participants; moderate-certainty evidence). Thrombolysis may result in little to no difference in haemorrhagic complications (10.3% versus 7.2%, RR 1.40, 95% CI 0.73 to 2.68; 6 studies, 341 participants; low-certainty evidence). Thrombolysis likely results in a reduction in cerebral artery vasospasm (32.9% versus 47.6%, RR 0.70, 95% CI 0.54 to 0.91; studies, participants; moderate-certainty evidence), and may result in a reduction in delayed cerebral ischaemia (23.8% versus 38.2%, RR 0.62, 95% CI 0.45 to 0.88; studies, participants; low-certainty evidence). Thrombolysis may result in little to no difference in cerebral infarction (28.6% versus 37.5%, RR 0.76, 95% CI 0.44 to 1.31; studies, participants; low-certainty evidence), and likely results in little to no difference in the risk of hydrocephalus (18.3% versus 24.1%, RR 0.77, 95% CI 0.54 to 1.10; studies, participants; moderate-certainty evidence). There is some evidence that thrombolysis can probably improve outcomes after aneurysmal subarachnoid haemorrhage, without increasing the risk of haemorrhagic complications. Thrombolysis likely reduces the risk of poor functional outcome and cerebral artery vasospasm, and may reduce the risk of delayed cerebral ischaemia, but it likely makes little to no difference to case fatality or hydrocephalus, and may make little to no difference to the risk of cerebral infarction. However, the current evidence is still uncertain. The uncertainty is primarily due to the small total number of participants and outcome events. Data from further studies are required to confirm the efficacy of thrombolysis for improving outcomes after aneurysmal subarachnoid haemorrhage.