Current Clinical Guidelines Research Articles

Refining colorectal cancer screening strategies using polygenic risk scores and classical risk factors: A proof-of-concept study in the UK Biobank cohort.

104 Background: While the rising incidence of CRC in younger populations has led to a push for lowering the screening age to 40, current clinical guidelines lack sufficient consideration of individual risk variations, raising concerns about the potential harms of over-diagnosis and false positives. Our proof-of-concept study evaluates the utility of risk stratification for multi-target stool DNA (mt-sDNA) testing by integrating polygenic risk scores and traditional clinical risk factors, addressing gaps in current clinical CRC screening guidelines. Methods: Our study utilized the UK Biobank prospective cohort, consisting of 311,544 unrelated individuals of White British ancestry, aged 40-69, excluding those with any prior malignant cancer diagnosis. We developed a sex-specific Cox proportional hazards model to estimate the risk of developing CRC, with the primary outcome being the first incidence of CRC. Three models were assessed: a polygenic risk score (PRS)-only model, a classical risk factors (RF)-only model, and a combined (PRS + RF) model. The traditional risk factors considered were BMI, smoking status, pack years of smoking, and family history of bowel cancer in first-degree non-adoptive relatives. Model performance was evaluated using the area under the curve (AUC), hazard ratios (HR), and the positive and negative predictive values of mt-sDNA across various risk profiles. Results: The combined model for early CRC screening using mt-sDNA demonstrated superior risk stratification (Table) and improved PPV compared to the risk factors-only model, with enhanced performance even among younger individuals at lower baseline risk. If risk stratification was not used, the average PPV for the test in the general population (ages 40-80) would be 2.13% for males and 1.44% for females. In contrast, individuals in the top 1% of risk would have significantly higher PPVs: 5.62% for males and 3.51% for females. If we limit testing to only the high-risk group, per 100,000 individuals, approximately 3,490 additional cases for males and 2,070 additional cases for females would be detected compared to the average-risk population without stratification. Conclusions: The findings suggest that risk stratification may enhance the effectiveness of screening by identifying high-risk individuals who would derive the greatest benefit. In contrast, broad application of the test across the general population may not achieve an optimal risk-benefit ratio, given the relatively low PPV in average-risk individuals. Model performance of the PRS-only, RF-only, and PRS + RF (Combined) models for females and males, respectively. Hazard Ratio (95% CI) C-index (SE) 5-Year AUC Female PRS-Only 1.50 (1.37 - 1.64) 0.62 (0.01) 0.61 RF + PRS 1.49 (1.36 - 1.63) 0.62 (0.01) 0.61 RF Only 1.09 (0.99 - 1.20) 0.53 (0.02) 0.51 Male PRS-Only 1.49 (1.38 - 1.61) 0.63 (0.01) 0.69 RF + PRS 1.49 (1.38 - 1.61) 0.64 (0.01) 0.71 RF Only 1.23 (1.15 - 1.31) 0.57 (0.01) 0.57

Transcranial Doppler Arterial Pressure Gradient Is Associated With Delayed Infarction After Subarachnoid Hemorrhage.

While the pulsatility index (PI) measured by transcranial Doppler (TCD) has broader associations with outcomes in neurocritical care, its use in monitoring delayed cerebral infarction (DCI) in patients with aneurysmal subarachnoid hemorrhage (SAH) is not endorsed by current clinical guidelines. Recognizing that arterial pressure gradient (ΔP) can be estimated using PI, we investigated the potential significance of TCD-estimated ΔP. In this observational study of 186 SAH patients, we recorded the mean cerebral blood flow velocity (mCBFV) and PI values from the middle cerebral artery, along with corresponding blood pressures. Using a previously reported mathematical model, we estimated ΔP by dividing pulse pressure by PI. We investigated the association between ΔP and mCBFV values and two acute phase complications of SAH-DCI and angiographic vasospasm. Additionally, we explored the association between DCI, vasospasm, and 90-day functional outcome. Elevated ΔP was associated with DCI (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.004-1.039, p=0.014) but not vasospasm (OR 1.006, 95% CI 0.991-1.022, p=0.402). Elevated mCBFV was associated with vasospasm (OR 1.037, 95% CI 1.017-1.057, p<0.001) but not DCI (OR 0.998, 95% CI 0.979-1.018, p=0.873). DCI (OR 29.380, 95% CI 2.930-294.615, p=0.004), rather than vasospasm (OR 0.695, 95% CI 0.120-4.043, p=0.686), was associated with functional outcome. Increased ΔP, rather than elevated mCBFV, was associated with DCI. While elevated mCBFV was associated with vasospasm, it was not associated with DCI. Hence, TCD-estimated ΔP may serve as a predictor for the DCI in SAH patients, a condition that impacts long-term outcome.

Accelerating the momentum to achieve global elimination of hepatitis B infection: a scoping review of hepatitis B guidelines to reduce mother to child transmission.

Progress towards achieving global elimination of hepatitis B virus (HBV) by 2030 remains unsatisfactory. Prevention of mother to child transmission is crucial but current Clinical Practice Guidelines (CPGs) gave diverse recommendations, creating confusion and leading to significant challenges in the practical implementation across various regions owing to global inequity. We reviewed 47 CPGs on the management of hepatitis B during pregnancy against twelve important clinical questions. Of 47 guidelines, 80.9% (38/47) supported the universal approach to HBV screening. To select women for antiviral prophylaxis, 78.7% (37/47) recommended the use of HBV DNA levels, while 31.9% (15/47) recommended the use of HBeAg. Of 37 guidelines recommending HBV DNA levels, 94.6% (35/37) recommended a viral load threshold of >200,000 IU/mL to initiate antiviral prophylaxis. Of 16 guidelines addressing the mode of delivery, 87.5% (14/16) encouraged vaginal birth. Of 30 guidelines addressing breastfeeding, 60% (18/30) recommended breastfeeding. However, controversies were found in the optimal timing of HBV disease evaluation during pregnancy and the ideal timing to stop antiviral prophylaxis after delivery. Of 36 guidelines addressing the timing to initiate antiviral prophylaxis, 25% (9/36) advised starting prophylaxis between 24 and 28 weeks, while 75% (27/36) suggested other timings or provided vague descriptions. Of 38 guidelines addressing birth-dose vaccination, 42% (16/38) emphasized the importance of "vaccination as soon as possible after birth." These deficiencies and discrepancies among CPGs could significantly impede global HBV elimination.

The role of nutritional vitamin D in CKD-MBD in children and adults with CKD, on dialysis and after kidney transplantation - a European consensus statement.

Vitamin D deficiency is common in patients with chronic kidney disease (CKD) and associates with poor outcomes. Current clinical practice guidelines recommend supplementation with nutritional vitamin D as for the general population. However, recent large-scale, clinical trials in the general population failed to demonstrate a benefit of vitamin D supplementation on skeletal or non-skeletal outcomes, fueling a debate on the rationale for screening for and correcting vitamin D deficiency, both in non-CKD and CKD populations. In a collaboration between the European Renal Osteodystrophy initiative of the European Renal Association (ERA) and the European Society for Paediatric Nephrology (ESPN), an expert panel performed an extensive literature review and formulated clinical practice points on vitamin D supplementation in children and adults with CKD and after kidney transplantation. These were reviewed by a Delphi panel of members from relevant working groups of the ERA and ESPN. Key clinical practice points include recommendations to monitor for, and correct, vitamin D deficiency in children and adults with CKD and after kidney transplantation, targeting 25-hydroxyvitamin D levels >75nmol/L (>30ng/mL). While vitamin D supplementation appears well-tolerated and safe, it is recommended to avoid mega-doses (≥100 000 IU) and very high levels of 25 hydroxyvitamin D (>150-200nmol/L, or 60-80ng/mL) to reduce the risk of toxicity. Future clinical trials should investigate the benefit of vitamin D supplementation on patient-relevant outcomes in the setting of vitamin D deficiency across different stages of CKD.

A systematic review of the clinical practice guidelines for the assessment, management and treatment of eating disorders during the perinatal period

BackgroundEating disorders during the perinatal period can pose significant risks to both the mother and the baby. Clinical practice guidelines include statements of expected practice intending to improve effectiveness and quality of care within health care services. This systematic review aimed to identify and synthesise current clinical practice guideline recommendations on the assessment, management and treatment of eating disorders during the perinatal period.MethodsThree bibliographic databases and five guideline repository databases were searched alongside the grey literature. Guidelines were screened against eligibility criteria and recommendations for the assessment, management or treatment of eating disorders during the perinatal period were extracted. All included guidelines were assessed for quality using the AGREE-II tool. Recommendations were analysed and summarised using narrative synthesis.ResultsFrom the 242 records screened, 17 met inclusion criteria. Guideline quality ranged from three out of seven to seven out of seven. Six overall recommendations were formed from the narrative synthesis of data: 1) Early detection: recognising the signs and symptoms, 2) Assessment and screening: a three-pronged approach, 3) Educating and supporting the mother: the importance of knowledge, 4) Cross-system collaboration, 5) Psychological, pharmacological and medical treatment, and 6) Continued monitoring.ConclusionPerinatal eating disorder guideline recommendations were fairly consistent but showed considerable variability in quality and depth of recommendations. Recommendations require further contextualisation, to allow them to be operationalised and implemented within services. The review findings provide an initial framework for health care professionals responsible for supporting women with eating disorders during the perinatal period, and have several implications for policy, service delivery and health outcomes for women and their families.

Comparison of Spontaneous Breathing Trials in Clinical Practice and Current Clinical Practice Guidelines

Comparison of Spontaneous Breathing Trials in Clinical Practice and Current Clinical Practice Guidelines

Critical Review of Guidelines for Type B Aortic Dissection.

The management of type B aortic dissection is one of the most challenging and debated topics in contemporary cardiovascular surgery practice. Patients with acute or chronic dissection-related complications, face high morbidity and mortality if not treated promptly. For most patients requiring intervention, thoracic endovascular aortic repair (TEVAR) is considered the gold standard. However, both early and late TEVAR-related complications make decision-making complex, even for experienced clinicians. In many cases, optimal medical management with longitudinal imaging surveillance may be preferred. In response to these challenges, several societal guidelines have recently been published1-5 to provide evidence-based or expert consensus 'best practice' recommendations. Although these guidelines share many commonalities, they also highlight key unresolved clinical questions. For example, debates persist over the appropriate use of TEVAR for 'uncomplicated' TBAD, defining 'high-risk' criteria for uncomplicated presentations, and management of the false lumen, among other topics. Despite recent updates, a critical evaluation of the nuanced differences between these guidelines is lacking. Therefore, the purpose of this review is to compare current clinical practice guidelines, highlight their similarities and differences, and offer a comprehensive evaluation of the evidence surrounding management of TBAD. Moreover, this analysis will provide recommendations to address important knowledge gaps.

Delphi consensus on the diagnostic criteria of polycystic ovary syndrome.

To gather the current opinion among Italian gynecologists and endocrinologists regarding the definition, diagnosis, and treatment of polycystic ovary syndrome (PCOS). A Delphi survey consisting of 26 statements was designed by a nine-member panel (consisting of members from the Italian Society of Endocrinology (SIE) and the Experts Group AQon Inositol in Basic and Clinical Research and on PCOS (EGOI-PCOS)) and distributed to 102 experts in PCOS across the fields of gynecology and endocrinology. Consensus was defined as an agreement between at least 70% of responders. Participants completed three rounds of statements, ranking their level of agreement. Of the initial 26 statements, 25 reached an adequate consensus, with an overall response rate of 73%. The statements were divided into three sections: definition and current understanding, diagnosis, and treatment. Of the statements that reached consensus, near total agreement was reached in the first two sections, whereas there was a divergence of opinion in terms of optimum treatment strategy between the gynecology and endocrinology subgroups. It was agreed that the current clinical guidelines are inadequate for clinical and scientific practice, with most responders advocating for the inclusion of metabolic factors. Furthermore, the consensus opinion advocated for the diversification of hyperandrogenic vs. non-hyperandrogenic phenotypes. This survey gives a snapshot of the current understanding of PCOS in the Italian healthcare community.

Genetic variations underlying aminoglycoside resistance in antibiotic-induced Mycobacterium intracellulare mutants.

Mycobacterium avium complex (MAC) is an emerging pathogen leading to public health concerns in developing and developed countries, particularly among immunocompromised individuals and patients with structural lung diseases. Current clinical guidelines recommend combination antibiotic therapy for treating MAC pulmonary disease (MAC-PD). However, the rising prevalence of antibiotic resistance poses significant challenges, including treatment failure and clinical recurrence. A deeper understanding of the mechanisms underlying MAC antibiotic resistance is essential to improve treatment outcomes. This study investigates the genetic variations associated with aminoglycoside resistance in an antibiotic-induced Mycobacterium intracellulare mutant derived from a clinical strain. Whole-genome analysis identified seven mutations in the aminoglycoside-resistant mutant, including single nucleotide polymorphisms (SNPs) and insertions/deletions (InDels). Key genetic alterations included a frameshift variant in a gene encoding a secreted protein antigen, missense mutations in rpsL and rsmG, and synonymous and in-frame deletion variants in srfAB and mtrB, respectively. These findings highlight the complex genetic landscape of aminoglycoside resistance in M. intracellulare. Understanding these resistance determinants provides valuable insights for developing diagnostic tools to detect drug-resistant MAC strains and optimizing therapeutic strategies for managing MAC infections in clinical practice.

Society of American Gastrointestinal and Endoscopic Surgeons guidelines development: Clinical Practice Guideline Update Standard Operating Procedure.

The SAGES Guidelines Committee creates evidence-based clinical practice guidelines (CPGs). Updates which incorporate new evidence into the guidelines are necessary to maintain relevance for clinical use. A description of our standard operating procedure for this process is described here, which contributes to SAGES' commitment to producing high-quality clinical recommendations. This paper outlines the SAGES Clinical Practice Guideline Update Standard Operating Procedure in order to incorporate regular updates to our guideline development process. SAGES has developed an evidence-based, standardized approach in updating current clinical practice guidelines to ensure that physicians and patients have access to the most appropriate recommendations. Societies that promote guidelines within their organization must make an intentional effort to regularly evaluate the relevance of their recommendations. The SAGES Guidelines Update Standard Operating Procedure aims to provide a framework to reliably and systematically review existing guidelines and update them as needed.

Enhancing safety monitoring in post-stroke rehabilitation through wearable technologies

Objective Current clinical practice guidelines support structured, progressive protocols for improving walking after stroke. Technology enables monitoring of exercise and therapy intensity, but safety concerns could also be addressed. This study explores functional mobility in post-stroke individuals using wearable technology to quantify movement smoothness—an indicator of safe mobility. Design Observational cohort study. Setting A movement analysis and rehabilitation laboratory. Participants A total of 56 chronic post-stroke individuals and 51 healthy controls. Intervention Participants performed the mobility test while wearing an inertial measurement unit attached to their waist. Thirty-two healthy participants also engaged in a steady-state walking task. Main measures Functional mobility smoothness by examining angular velocities in the yaw, pitch, and roll axes, employing the spectral arc length metrics. Results Our findings reveal that post-stroke individuals extend the duration of the timed-up-and-go test (≈9 s and 23 s longer compared to the controls) to ensure safe mobility—greater mobility smoothness ( p &lt; 0.001). Notably, for mild and severe impairments, post-stroke mobility demonstrated ≈8% and ≈11% greater smoothness in pitch movements, respectively ( p = 0.025 and p = 0.002). In the roll direction, mobility was ≈12% smoother in cases of severe strokes ( p = 0.006). Conclusion This study addresses a crucial gap in the understanding of mobility smoothness in chronic stroke survivors using wearable technology. Our study suggests the potential utility of spectral arc length to predict challenging mobility situations in real-world situations. We highlight the potential for automated monitoring of safety offering promising avenues for real-time, real-life monitoring.

Expert opinions on influenza vaccination for patients with common cardiovascular diseases

The influenza virus is classified as a single-stranded negative-sense RNA virus in Orthomyxoviridae family, with epidemiological properties distinct from common cold. Previous studies have found that influenza infection can cause cardiac damage through various pathways, and patients with cardiovascular diseases are at relatively higher risk of adverse disease outcomes. Influenza vaccination has been proven to provide protective effect on patients with cardiovascular diseases. Currently, there is insufficient emphasis placed by cardiologists and cardiovascular disease patients on the prevention of influenza infection, leading to a low influenza vaccination rate in China. Therefore, based on the current clinical research progress and relevant guidelines, combined with the safety, feasibility and health economic benefits of influenza vaccinating in patients with cardiovascular diseases, as well as clinical experience from experts, this article proposes expert opinions on influenza vaccination in common cardiovascular diseases aiming to raise awareness of influenza prevention and benefiting patients.

Advanced Restriction Imaging and Reconstruction Technology for Prostate Magnetic Resonance Imaging (ART-Pro): A Study Protocol for a Multicenter, Multinational Trial Evaluating Biparametric Magnetic Resonance Imaging and Advanced, Quantitative Diffusion Magnetic Resonance Imaging for the Detection of Prostate Cancer.

Multiparametric magnetic resonance imaging (mpMRI) is strongly recommended by current clinical guidelines for improved detection of clinically significant prostate cancer (csPCa). However, the major limitations are the need for intravenous (IV) contrast and dependence on reader expertise. Efforts to address these issues include use of biparametric magnetic resonance imaging (bpMRI) and advanced, quantitative magnetic resonance imaging (MRI) techniques. One such advanced technique is the Restriction Spectrum Imaging restriction score (RSIrs), an imaging biomarker that has been shown to improve quantitative accuracy of patient-level csPCa detection. Advanced Restriction imaging and reconstruction Technology for Prostate MRI (ART-Pro) is a multisite, multinational trial that aims to evaluate whether IV contrast can be avoided in the setting of standardized, state-of-the-art image acquisition, with or without addition of RSIrs. Additionally, RSIrs will be evaluated as a stand-alone, quantitative, objective biomarker. ART-Pro will be conducted in two stages and will include a total of 500 patients referred for multiparametric prostate MRI with a clinical suspicion of prostate cancer at the participating sites. ART-Pro-1 will evaluate bpMRI, mpMRI, and RSIrs on the accuracy of expert radiologists' detection of csPCa and will evaluate RSIrs as a stand-alone, quantitative, objective biomarker. ART-Pro-2 will evaluate the same MRI techniques on the accuracy of nonexpert radiologists' detection of csPCa, and findings will be evaluated against the expertly created dataset from ART-Pro-1. The primary endpoint is to evaluate whether bpMRI is noninferior to mpMRI among expert (ART-Pro-1) and nonexpert (ART-Pro-2) radiologists for the detection of grade group ≥2 csPCa. This trial is registered in the US National Library of Medicine Trial Registry (NCT number: NCT06579417) at ClinicalTrials.gov. Patient accrual at the first site (UC San Diego) began in December 2023. Initial results are anticipated by the end of 2026.

Gaps in Evidence-Based Recommendations for Low Back Pain: Analysis of the Accuracy of the Care Pathway in Primary Care.

Primary health care is the gateway to low back pain (LBP) management. Effective management of LBP can reduce disability and socioeconomic burden. Standardised, accurate, and evidence-based information for assertive decision-making in care pathways for LBP has the potential to improve health service efficiency. To describe and analyse the accuracy of the information on the care pathway for the management of LBP in primary care provided by the Ministry of Health from Brazil. Descriptive study of the accuracy of information on the care pathway for LBP in primary care based on an official protocol of the Ministry of Health from Brazil. Information on non-pharmacological and pharmacological treatment, as well as health education, was extracted from the treatment protocol. The information was then compared with recent international guidelines for accuracy analysis. Each management recommendation was analysed by two independent researchers and classified as accurate, partially accurate, inaccurate or not mentioned according to the clarity and precision of the information. The analysis revealed that 43% of the management recommendations were accurate, 30% were partially accurate, and 26% of the recommendations presented in the investigated guidelines were not mentioned in the Ministry of Health's care pathway. Pharmacological recommendations showed 50% accuracy, non-pharmacological recommendations 60%, and health education recommendations 14%. Additionally, the care pathway appears to be outdated in recommending educational guidance that is not aligned with current clinical guidelines. The results indicate that, although there some aspects of the information provided by the Brazilian official management protocol align with international clinical guidelines, there are substantial gaps, especially in the areas of health education and non-pharmacological interventions. This study may contribute to making more accurate information available on LBP, bringing primary care professionals in Brazil closer to evidence-based recommendations.

СОВРЕМЕННЫЕ ПОДХОДЫ К ЛЕЧЕНИЮ ПАЦИЕНТОВ С ДИСТАЛЬНОЙ ОККЛЮЗИЕЙ И ДИСФУНКЦИЕЙ ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА В ОРТОДОНТИЧЕСКОЙ ПРАКТИКЕ. ОБЗОР ЛИТЕРАТУРЫ

The article provides a structured review of the scientific literature on the treatment of distal occlusion and dysfunction of the temporomandibular joint (TMJ). When studying the combination of distal occlusion with TMJ dysfunction, the results show that this combined pathology is present in 28.1% of cases in adolescents and increases significantly to 57.9% in adults [24,40,45,48,20]. Orthodontists are often the first specialists to encounter TMJ dysfunction, especially because adolescents often seek orthodontic treatment during a period of active body growth. However, current clinical guidelines and national protocols lack a clear diagnostic and therapeutic pathway to address the problem of distal occlusion in young patients who already show signs of TMJ disorder [28]. For adolescent patients, orthodontists need to develop modern diagnostic and therapeutic approaches that can prevent the progression of symptoms of temporomandibular joint dysfunction. In adult cases where loss of occlusion height and TMJ dysfunction coexist, the solution requires a comprehensive approach involving close collaboration between different dentists. Thus, solving the combined pathology of distal occlusion and TMJ dysfunction in both adolescents and adults is a significant problem in orthodontic practice. As a result, the article concludes that algorithms for the treatment of this complex of pathologies are not enough. The need for a comprehensive, age-specific treatment protocol underscores the importance of interdisciplinary strategies in orthodontic practice for effective management of this complex pathology in different age groups.

Pragmatic non-inferiority Randomised trial Investigating Needle aspiration versus ChEst drain for Secondary Spontaneous Pneumothorax (the PRINCE-SSP study): study protocol for a randomised non-inferiority trial

IntroductionSecondary spontaneous pneumothorax (SSP) is a medical emergency where the lung collapses in the presence of underlying chronic lung disease. Current international clinical guidelines advise intercostal drain (ICD) insertion for...

Review of drugs effective in Alzheimer's disease

The authors set out to review the drugs that are most effective in treating Alzheimer's disease. For this purpose, a review of modern scientific literature regarding current approaches to the treatment and prevention of Alzheimer's disease, a review of current clinical guidelines for the treatment of Alzheimer's disease, and determination of the compliance of drug prescriptions in real clinical practice were carried out; the forms and methods of conducting awareness-raising work on the prevention of Alzheimer's disease in pharmacy practice were analyzed. The results of the study became the basis for identifying specific approaches to optimize drug therapy and prevent Alzheimer's disease.

Predictors of Left Ventricular Ejection Fraction Decrease in Patients With ST-Segment Elevation Myocardial Infarction.

To identify predictors and construct a model for predicting left ventricular (LV) ejection fraction (EF) in patients with ST-segment elevation myocardial infarction (STEMI). This was a prospective registry study of patients with STEMI admitted within the first 24 hours of the disease onset. Patients were evaluated and treated according to the current clinical guidelines. On the first day of STEMI, concentrations of growth stimulating factor, proprotein convertase subtilisin-kexin type 9 (PCSK9), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity troponin I and C-reactive protein were measured. Echocardiography was performed on the first day and on day 10-12 of admission; LVEF was calculated by the Simpson method. The study included 138 patients; 3 patients were excluded from this part of the study due to death before repeat echocardiography. Based on the LVEF value on day 10-12 of STEMI, the patients were divided into the groups with preserved LVEF (pLVEF) ≥50% (n=34), reduced LVEF (rLVEF) ≤40% (n=21), and moderately reduced LVEF (mrLVEF) 41-49% (n=80). The ordinal regression analysis showed that the factors influencing LVEF in STEMI patients included a history of chronic heart failure, Killip class II-IV acute heart failure at the index hospitalization, the development of LV dilation and postinfarction aneurysm, and an increase in NTproBNP. Based on the obtained estimates of the regression parameters, a prognostic model was constructed that showed the highest sensitivity of the model for predicting rLVEF, 94.4%, mrLVEF, 92.9%, and a lower sensitivity for predicting pLVEF, 62.5%. In the presence of a history of chronic heart failure, Killip class II-IV acute heart failure, developed LV dilation and postinfarction aneurism, and elevated NTproBNP, patients with STEMI are expected to have lower LVEF values.

Artificial intelligence-powered solutions for automated aortic diameter measurement in computed tomography: a narrative review.

Patients with thoracic aortic aneurysm and dissection (TAAD) are often asymptomatic but present acutely with life threatening complications that necessitate emergency intervention. Aortic diameter measurement using computed tomography (CT) is considered the gold standard for diagnosis, surgical planning, and monitoring. However, manual measurement can create challenges in clinical workflows due to its time-consuming, labour-intensive nature and susceptibility to human error. With advancements in artificial intelligence (AI), several models have emerged in recent years for automated aortic diameter measurement. This article aims to review the performance and clinical relevance of these models in relation to clinical workflows. We performed literature searches in PubMed, Scopus, and Web of Science to identify relevant studies published between 2014 and 2024, with the focus on AI and deep learning aortic diameter measurements in screening and diagnosis of TAAD. Twenty-four studies were retrieved in the past ten years, highlighting a significant knowledge gap in the field of translational medicine. The discussion included an overview of AI-powered models for aortic diameter measurement, as well as current clinical guidelines and workflows. This article provides a thorough overview of AI and deep learning models designed for automatic aortic diameter measurement in the screening and diagnosis of thoracic aortic aneurysms (TAAs). We emphasize not only the performance of these technologies but also their clinical significance in enabling timely interventions for high-risk patients. Looking ahead, we envision a future where AI and deep learning-powered automatic aortic diameter measurement models will streamline TAAD clinical management.

Prognostic factors and impact of management strategies for status epilepticus: The STEPPER study in the Emilia-Romagna region, Italy.

The STEPPER (Status Epilepticus in Emilia-Romagna) study aimed to investigate the clinical characteristics, prognostic factors, and treatment approaches of status epilepticus (SE) in adults of the Emilia-Romagna region (ERR), Northern Italy. STEPPER, an observational, prospective, multicentric cohort study, was conducted across neurology units, emergency departments, and intensive care units of the ERR over 24 months (October 2019-October 2021), encompassing incident cases of SE. Patients were followed up for 30 days. A total of 578 cases were recruited (56% female, mean age = 70 years, 32% with previous diagnosis of epilepsy, 43% with in-hospital onset, 35% stuporous/comatose, 46% with nonconvulsive SE). Etiology was known in 87% (acute 43%, remote 24%, progressive 17%, definite epileptic syndrome 3%). The mean pre-SE Rankin Scale score was 2, the Status Epilepticus Severity Score was ≥4 in 33%, the Epidemiology-Based Mortality Score in Status Epilepticus score was ≥64 in 61%, and 34% were refractory. The sequence of treatments followed current clinical practice guidelines in 63%. Benzodiazepines (BDZs) were underused as first-line therapy (71%), especially in in-hospital onset cases; 15% were treated with continuous intravenous anesthetic drugs. Mortality was 24%; 63% of survivors had functional worsening. At the two-step multivariable analysis, incorrect versus correct treatment sequence with correct BDZ dose was the strongest predictor of failure to resolve SE in the in-hospital group (odds ratio [OR] = 4.42, 95% confidence interval [CI] = 1.86-10.5), with a similar trend in the out-of-hospital group (OR = 2.22, 95% CI = .98-5.02). In turn, failure to resolve was the strongest predictor of 30-day mortality (OR = 11.3, 95% CI = 4.16-30.9, out-of-hospital SE; OR = 6.42, 95% CI = 2.79-14.8, in-hospital SE) and functional worsening (OR = 5.83, 95% CI = 2.05-16.6, out-of-hospital SE; OR = 9.30, 95% CI 2.22-32.3, in-hospital SE). The STEPPER study offers insights into real-world SE management, highlighting its significant morbidity and functional decline implications. Although nonmodifiable clinical factors contribute to SE severity, modifiable factors such as optimized first-line therapies and adherence to guidelines can potentially influence prognosis.