Daily Clinical Practice Research Articles

The Past, the Present and the Future of Teledermatology: A Narrative Review.

Teledermatology may be defined as the application of telemedicine to dermatology. According to published data, teledermatology is more widespread in Europe and North America, probably where resources for health care are greater than in other areas of the world. Indeed, teledermatology requires advanced technology to be efficient, as high image quality is necessary to allow the dermatologist to make correct diagnoses. Thanks to the recent advances in this field, teledermatology is become routinary in daily clinical practice. However, its use has been improved over time, overcoming several challenges. The aim of this narrative review is to retrace the almost 30-year history of teledermatology, to address the new challenges posed by advancing technologies such as artificial intelligence and the implications it may have on healthcare.

Usefulness of Non-Invasive Parameters (Inferior Vena Cava Diameter, Inferior Vena Cava Collapsibility, Inferior Vena Cava-Aortic Ratio) for Hemodynamic Monitoring in Critically Ill Children: A Systematic Review.

Volume measurement in critically ill children can be conducted using invasive procedure such as Central Venous Pressure (CVP), or non-invasive procedure such as measurement of Inferior Vena Cava (IVC) indices using ultrasonography. However, their accuracy and efficacy are still under scrutiny. We aim to compare CVP and IVC indices as non-invasive parameters in assessing volume status in critically ill children. We conducted a systematic review based on literature searching from four electronic databases which were PubMed, Cochrane, ScienceDirect, SpringerLink with keywords: "CENTRAL VENOUS PRESSURE", "INFERIOR VENA CAVA DIAMETER", "INFERIOR VENA CAVA COLLAPSIBILITY", "INFERIOR VENA CAVA AORTIC-RATIO", "VOLUME STATUS", "FLUID STATUS", "CRITICAL ILL", "CHILDREN", and "PEDIATRICS". We included relevant studies in English published from 2000 to 2023 on critically ill children aged 0-18 years. Comparison between CVP and IVC indices was resumed. Eight articles were included in this study. Majority of the studies showed a consistent correlation between CVP and IVC indices. IVC-CI was the most common parameter evaluated in the included studies. There was moderate to strong correlations using IVC-CI and IVC-DI, and moderate correlation using IVC-Ao ratio. We found that non-invasive tools might have a potential role to measure volume in critically ill children equals to CVP. Further high-quality and longitudinal studies are needed to validate these findings and to establish a clear guideline for the non-invasive tool to be used in daily clinical practice.

Writing Case Reports Can Improve Seven Components in Clinical Reasoning.

Case reports provide scientific knowledge and opportunities for new clinical research. However, it is estimated that less than 5% of cases presented by Japanese generalists at academic conferences are published due to various barriers such as the complex process of writing articles, conducting literature searches, the significant time required, the reluctance to write in English, and the challenge of selecting appropriate journals for publication. Therefore, the purpose of this opinion paper is to provide clinicians with practical tips for writing case reports that promote diagnostic excellence. In recent years, clinical practitioners have been striving for diagnostic excellence and optimal methods to accurately and comprehensively understand the patient's condition. To write a case report, it is essential to be mindful of the elements of diagnostic excellence and consider the quality of the diagnostic reasoning process. We (the authors) are seven academic generalists who are members of the Japanese Society of Hospital General Medicine (JSHGM) - Junior Doctors Association, with a median of 7 years after graduation and extensive experience publishing case reports in international peer-reviewed journals. We conducted a narrative review and discussed ways to write case reports to promote diagnostic excellence, leveraging our unique perspectives as academic generalists. Our review did not identify any reports addressing the critical points in writing case reports that embody diagnostic excellence. Therefore, this report proposes a methodology that describes the process involved in writing diagnostic excellence-promoting case reports and provides an overview of the lessons learned. Based on our review and discussion, we explain the essential points for promoting diagnostic excellence through case reports categorized into seven components of clinical reasoning. These strategies are useful in daily clinical practice and instrumental in promoting diagnostic excellence through case reports.

Multimodality imaging of acute and chronic pulmonary thromboembolic disease.

Pulmonary embolism (PE) is a pathological entity characterised by venous thromboembolism in the pulmonary arteries. It is a common entity in daily clinical practice and is the third most common cause of cardiovascular death. Correct diagnostic work-up is pivotal to ensure timely institution of appropriate therapy. This requires recognition of the characteristic imaging findings and awareness of the role and peculiarities of the different imaging techniques involved in the diagnostic and therapeutic process. This review aims to showcase the most commonly encountered imaging findings associated with pulmonary thromboembolism for each imaging modality, outline their advantages and disadvantages, and define the specific role of these techniques in the clinical setting. The latest innovations concerning the diagnostic work-up of PE will be also briefly discussed, yielding a perspective on the future developments and challenges that the radiologist will have to face in the coming years.

A computer-aided polyp detection system in screening and surveillance colonoscopy: an international, multicentre, randomised, tandem trial

Studies on the effect of computer-aided detection (CAD) in a daily clinical screening and surveillance colonoscopy population practice are scarce. The aim of this study was to evaluate a novel CAD system in a screening and surveillance colonoscopy population. This multicentre, randomised, controlled trial was done in ten hospitals in Europe, the USA, and Israel by 31 endoscopists. Patients referred for non-immunochemical faecal occult blood test (iFOBT) screening or surveillance colonoscopy were included. Patients were randomomly assigned to CAD-assisted colonoscopy or conventional colonoscopy; a subset was further randomly assigned to undergo tandem colonoscopy: CAD followed by conventional colonoscopy or conventional colonoscopy followed by CAD. Primary objectives included adenoma per colonoscopy (APC) and adenoma per extraction (APE). Secondary objectives included adenoma miss rate (AMR) in the tandem colonoscopies. The study was registered at ClinicalTrials.gov, NCT04640792. A total of 916 patients were included in the modified intention-to-treat analysis: 449 in the CAD group and 467 in the conventional colonoscopy group. APC was higher with CAD compared with conventional colonoscopy (0·70 vs 0·51, p=0·015; 314 adenomas per 449 colonoscopies vs 238 adenomas per 467 colonoscopies; poisson effect ratio 1·372 [95% CI 1·068-1·769]), while showing non-inferiority of APE compared with conventional colonoscopy (0·59 vs 0·66; p<0·001 for non-inferiority; 314 of 536 extractions vs 238 of 360 extractions). AMR in the 127 (61 with CAD first, 66 with conventional colonoscopy first) patients completing tandem colonoscopy was 19% (11 of 59 detected during the second pass) in the CAD first group and 36% (16 of 45 detected during the second pass) in the conventional colonoscopy first group (p=0·024). CAD increased adenoma detection in non-iFOBT screening and surveillance colonoscopies and reduced adenoma miss rates compared with conventional colonoscopy, without an increase in the resection of non-adenomatous lesions. Magentiq Eye.

Autoimmune Skin Diseases in Multiple Sclerosis: Comorbidity Issues and the Impact of Pathogenetic Therapy

The number of autoimmune diseases (AS), currently numbering more than 100 nosological forms, is constantly growing and is a significant problem of clinical medicine. Advances in the definition of diagnostic biomarkers and clinical tests make it possible in most cases to carry out differential diagnosis of autoimmune pathology and prescribe personalized immunocorrection. The modern understanding of the mechanisms of AS is based on the breakdown of tolerance to their own antigens, which occurs in genetically predisposed individuals against the background of impaired immunoregulation. In this review, using the example of multiple sclerosis (MS) as a classic AS of the nervous system, a possible combination of common autoimmune mechanisms of MS and such common skin diseases as psoriasis and atopic dermatitis is considered. Advances in the field of pharmacy have accelerated the path from the creation of new molecules to the introduction of modern pathogenetic drugs into daily clinical practice. To prevent exacerbations and progression of MS, disease-modifying therapy of MS are currently used. This treatment is permanent and long-term, and it is very important to take into account the comorbid pathologies that develop against the background of this therapy. The review shows the effect of DMT on the manifestation of skin diseases. The use of modern bioengineered drugs can contribute both to the activation and emergence of new diseases, and to stabilize the patient’s condition in the presence of autoimmune comorbidity.

House dust mite sublingual allergen immunotherapy tablet is safe and well-tolerated in Dutch clinical practice.

Half (49%) of clinically diagnosed allergic rhinitis (AR) patients are sensitized to house dust mite (HDM). If allergen avoidance and symptomatic medication fail, allergen immunotherapy may be indicated. We investigated safety and tolerability of HDM-sublingual immunotherapy by HDM-SLIT tablets in Dutch daily clinical practice. Daily intake of 12 SQ-HDM SLIT-tablet was investigated in a prospective, multicenter, observational study (EUPAS43753). It comprised 4 consultations in 1 year. Data on safety, tolerability, treatment satisfaction, symptomatic medication, compliance, and clinical effectiveness (Control of Allergic Rhinitis and Asthma Test; CARAT) were collected. Descriptive and longitudinal regression data analysis were performed. Adult patients (n = 415), mean (SD) age 36.6 (12.2) years, 61.4% female and 36% asthmatic were included. The preponderance (65.1%) experienced adverse events (AEs). These, mostly mild (67%), AEs comprised: oral allergic reactions (58.6%), respiratory (12.4%) and gastrointestinal symptoms (9.4%). Sixty (14.5%) patients stopped due to AEs and 76 (18.3%) for non-AE reasons. CARAT scores improved clinically significant by 6 points and symptomatic medication use decreased from 96.1% to 77.4%. Most patients (74.5%) tolerated the treatment and were compliant (>86.5%). The majority of patients (62.4%) and investigators (69.4%) were satisfied with treatment. HDM SLIT-tablet is a safe and well-tolerated AR treatment. AEs occur often but are mostly mild and decreasing during the first year. CARAT scores improved and symptomatic medication use decreased suggesting better control of AR with treatment. Compliance, tolerability, and treatment satisfaction are good. However, patient follow-up and compliance remain important points of attention when initiating treatment.

Patient Impression of Improvement 1 year After Sacrospinous Hysteropexy Versus Vaginal Hysterectomy in Women with Pelvic Organ Prolapse Stage 2 or Higher

Introduction and hypothesisPatient-reported outcomes are relevant outcomes in studies on pelvic organ prolapse (POP) surgery, as anatomical recurrence alone does not have a significant correlation with perceived improvement. In the present study, the patient’s impression of improvement after 1 year is studied after vaginal hysterectomy (VH) versus sacrospinous hysteropexy (SSH) in large cohorts from daily clinical practice. We hypothesize that there is no difference between the groups.MethodsThis is a secondary analysis on prospectively collected data in a multicenter cohort of patients who underwent VH or SSH for symptomatic POP. All patients had a POP-Q stage ≥ 2 in at least one compartment at baseline and were treated with VH or SSH between 2002 and 2019. The primary outcome was the patient-reported score on the patient global impression of improvement index (PGI-I) 1 year after surgery. The secondary outcome was a composite outcome of surgical success, defined as the absence of recurrent POP beyond the hymen with bothersome bulge symptoms and/or repeat surgery.ResultsA total of 378 women (196 VH and 182 SSH) were included. The median score on the PGI-I did not differ between VH and SSH. At 1 year post-operatively, 77 women after VH (73%) and 77 women after SSH (75%) considered their condition (very) much improved (p = 0.86). There was no difference in composite outcome of surgical success (126 out of 137 women [92%] after VH, 118 out of 125 women [94%] after SSH; p = 0.44).ConclusionsOur study shows that there was no difference in the type of surgery, VH or SSH, with regard to the patient’s impression of improvement 1 year postoperatively in a large cohort from daily clinical practice.

Development and validation of a simplified risk prediction model for preterm birth: a prospective cohort study in rural Ethiopia

Preterm birth is one of the most common obstetric complications in low- and middle-income countries, where access to advanced diagnostic tests and imaging is limited. Therefore, we developed and validated a simplified risk prediction tool to predict preterm birth based on easily applicable and routinely collected characteristics of pregnant women in the primary care setting. We used a logistic regression model to develop a model based on the data collected from 481 pregnant women. Model accuracy was evaluated through discrimination (measured by the area under the Receiver Operating Characteristic curve; AUC) and calibration (via calibration graphs and the Hosmer–Lemeshow goodness of fit test). Internal validation was performed using a bootstrapping technique. A simplified risk score was developed, and the cut-off point was determined using the “Youden index” to classify pregnant women into high or low risk for preterm birth. The incidence of preterm birth was 19.5% (95% CI:16.2, 23.3) of pregnancies. The final prediction model incorporated mid-upper arm circumference, gravidity, history of abortion, antenatal care, comorbidity, intimate partner violence, and anemia as predictors of preeclampsia. The AUC of the model was 0.687 (95% CI: 0.62, 0.75). The calibration plot demonstrated a good calibration with a p-value of 0.713 for the Hosmer–Lemeshow goodness of fit test. The model can identify pregnant women at high risk of preterm birth. It is applicable in daily clinical practice and could contribute to the improvement of the health of women and newborns in primary care settings with limited resources. Healthcare providers in rural areas could use this prediction model to improve clinical decision-making and reduce obstetrics complications.

Transition of care of adolescents with rheumatic diseases in Saudi Arabia, current practice and obstacles

BackgroundThe importance of transition of care for adolescents with rheumatological illnesses from pediatric to adult rheumatology is increasing as the childhood rheumatologic diseases continue to adulthood. Despite that, transition practice in Saudi Arabia is not yet well-developed. ObjectivesThis study aims to evaluate the current transition of care practice for adolescents with rheumatological diseases to the adult healthcare facilities and the obstacles in achieving the best transition of care in Saudi Arabia. Setting and methodsThis is a non-interventional cross-sectional study conducted using an online survey that was distributed to pediatric and adult rheumatologists in Saudi Arabia. Google forms and Microsoft Excel 2016 were used for data entry and analysis. Descriptive statistics, frequencies and percentages were performed for categorical variables. ResultsA total number of 60 rheumatologists (27 pediatric and 33 adult) participated in the survey. Fifty-six (94%) of the participants do not follow any standardized programs for transition of care. All participants agreed on the need for a defined protocol for transition of care. The major barriers for successful transition of care were lack of protocols (63%), lack of healthcare providers (56%), and lack of well-developed systems that makes it difficult to access patient's electronic health records (55%). ConclusionA well-structured protocol for transition of care of adolescents with rheumatologic illnesses from pediatric to adult rheumatology in Saudi Arabia is still an unmet need. Efforts should be directed towards improving the practice of transition of care by establishing this protocol, enhancing the connectivity between pediatric and adult healthcare facilities, and encouraging pediatric and adult rheumatologists to adapt the transition of care protocol in their daily clinical practice.

Genetic Counseling and Genetic Testing for Familial Hypercholesterolemia.

Familial hypercholesterolemia (FH) is one of the most common autosomal codominant Mendelian diseases. The major complications of FH include tendon and cutaneous xanthomas and coronary artery disease (CAD) associated with a substantial elevation of serum low-density lipoprotein levels (LDL). Genetic counseling and genetic testing for FH is useful for its diagnosis, risk stratification, and motivation for further LDL-lowering treatments. In this study, we summarize the epidemiology of FH based on numerous genetic studies, including its pathogenic variants, genotype-phenotype correlation, prognostic factors, screening, and usefulness of genetic counseling and genetic testing. Due to the variety of treatments available for this common Mendelian disease, genetic counseling and genetic testing for FH should be implemented in daily clinical practice.

Utility of UV Signature Mutations in the Diagnostic Assessment of Metastatic Head and Neck Carcinomas of Unknown Primary.

Metastatic carcinoma of unknown primary origin to the head and neck lymph nodes (HNCUP) engenders unique diagnostic considerations. In many cases, the detection of a high-risk human papillomavirus (HR-HPV) unearths an occult oropharyngeal squamous cell carcinoma (SCC). In metastatic HR-HPV-independent carcinomas, other primary sites should be considered, including cutaneous malignancies that can mimic HR-HPV-associated SCC. In this context, ultraviolet (UV) signature mutations, defined as ≥ 60% C→T substitutions with ≥ 5% CC→TT substitutions at dipyrimidine sites, identified in tumors arising on sun exposed areas, are an attractive and underused tool in the setting of metastatic HNCUP. A retrospective review of institutional records focused on cases of HR-HPV negative HNCUP was conducted. All cases were subjected to next generation sequencing analysis to assess UV signature mutations. We identified 14HR-HPV negative metastatic HNCUP to either the cervical or parotid gland lymph nodes, of which, 11 (11/14, 79%) had UV signature mutations, including 4 (4/10, 40%) p16 positive cases. All UV signature mutation positive cases had at least one significant TP53 mutation and greater than 20 unique gene mutations. The management of metastatic cutaneous carcinomas significantly differs from other HNCUP especially metastatic HR-HPV-associated SCC; therefore, the observation of a high percentage of C→T with CC →TT substitutions should be routinely incorporated in next generation sequencing reports of HNCUP. UV mutational signatures testing is a robust diagnostic tool that can be utilized in daily clinical practice.

A wolf in sheep's clothing-aortic stenosis and cardiac amyloidosis: "RAISE"ing awareness in clinical practice.

Aesop's fable of the wolf in sheep's clothing encourages us to look beneath the exterior appearance of a situation and evaluate the truth that lies beneath. This concept should be applied when managing older patients with severe aortic stenosis. This population of patients is increasingly being identified as having concomitant cardiac amyloidosis, which is an underrecognized cause of common cardiac conditions. The presence of cardiac amyloidosis negatively affects the outcome of patients with aortic stenosis, these patients undergo transcatheter aortic valve replacement (TAVR) with increasing frequency and have a significantly higher overall mortality rate than patients with aortic stenosis alone. Although left ventricular wall hypertrophy is expected in patients with aortic stenosis, it should not be assumed that this is caused only by aortic stenosis. A suspicion of cardiac amyloidosis should be raised in patients in whom the degree of hypertrophy is disproportionate to the degree of aortic stenosis severity. The remodeling, age, injury, systemic, and electrical (RAISE) score was developed to predict the presence of cardiac amyloidosis in patients with severe aortic stenosis. This article highlights the value of increased clinical suspicion, demonstrates the use of the multiparameter RAISE score in daily clinical practice, and illustrates the scoring system with case studies. In elderly patients being considered for TAVR, systematic testing for cardiac amyloidosis should be considered as part of the preoperative workup.

Perbandingan Hipertensi pada Masyarakat Yang Tinggal di Pesisir Pulau Maitara dan Daerah Dataran Tinggi Gurabunga Tidore

Hypertension is a commonly encountered disease in daily clinical practice, but often goes unnoticed by its sufferers. Complications can occur in various organs, with the most significant being complications affecting the heart. The environment plays a role in hypertension, where inhabitants living in coastal areas tend to suffer from hypertension due to high sodium consumption, while in highland areas, hypertension is more influenced by acute hyperbaric hypoxia conditions, although its pathophysiology is not yet precisely known. Various studies have yielded diverse results. North Maluku Province is an archipelagic region with a large coastal area, and no research has been conducted there, prompting this study. An analytical observational study was conducted using a cross-sectional approach, focusing on the population of hypertensive individuals residing in the coastal area of Maitara and the highland area of Gurabunga, Tidore. Samples were consecutively selected until the required sample size was met. Variables examined included gender, age, occupation, salt consumption patterns, body mass index, ancestry, alcohol consumption habits, systolic blood pressure, and diastolic blood pressure. Analysis was performed using an independent t-test when sample homogeneity conditions were met. Significant differences were found in some demographic-clinical variables. There was a significant difference in diastolic blood pressure between the Gurabunga area and the coastal area of Maitara, but no significant difference was observed in systolic blood pressure.&#x0D; &#x0D;

Manufacturing Accuracy, Intaglio Surface Adaptation, and Survival of Additively and Subtractively Manufactured Definitive Resin Crowns After Cyclic Loading: An In Vitro Study.

To assess the manufacturing accuracy, intaglio surface adaptation, and survival of resin-based CAD/CAM definitive crowns created via additive manufacturing (AM) or subtractive manufacturing (SM). A maxillary right first molar crown was digitally designed and manufactured using AM hybrid resin composite (VarseoSmile Crown Plus, Bego [AM-HRC]), AM glass filler-reinforced resin composite (Crowntec, Saremco Dental [AM-RC]), and SM polymer-infiltrated ceramic (Vita Enamic, VITA Zahnfabrik [SM-PICN]). Manufacturing accuracy (trueness and precision) was assessed by computing the root mean square (RMS) error (in μm; n = 15 per material). Intaglio surface adaptation was assessed by calculating the average gap distance (μm). Ten crowns from each group were cemented on fiberglass-reinforced epoxy resin dies and cyclically loaded to simulate 5 years of functional loading. One-way ANOVA, post hoc Bonferroni comparison tests, and Levene's test were used to analyze the data (α = .05). AM-RC had higher overall trueness than AM-HRC and SM-PICN (P ≤ .05), whereas the trueness of AM-RC on the external surface was similar to that of SM-PICN (P = .99) and higher than AM-HRC (P = .001). SM-PICN had lower precision than AM-RC and AM-HRC overall and at internal occlusal surfaces (P ≤ .05). Overall intaglio surface adaptation was similar between all groups (P = .531). However, for the axial intaglio surface, AM-RC and AM-HRC had higher adaptation than SM-PICN (P ≤ .05). All tested crowns survived the cyclic loading simulation of 5 years clinical use. AM-RC showed high manufacturing accuracy and adaptation. The tested resin-based CAD/CAM materials demonstrated clinically acceptable manufacturing accuracy and simulated medium-term durability, justifying the initiation of clinical investigations to determine their potential implementation in daily clinical practice.

Real-World Data and Clinical Implications of Next-Generation Sequencing (NGS)-Based Analysis in Metastatic Breast Cancer Patients.

Over the last two decades, the use of Next-Generation Sequencing (NGS) in medical oncology has increased the likelihood of identifying druggable mutations that may be potentially susceptible to targeted treatments. The European Society for Medical Oncology (ESMO) currently does not recommend the use of the NGS test to determine the therapeutic course of patients with metastatic breast cancer (mBC) in daily clinical practice. However, the aim of this work is to evaluate the potential contribution of the NGS test in selecting targeted therapies for patients with mBC. Data were retrospectively collected from 101 patients diagnosed with metastatic breast cancer and treated at the Modena Cancer Center between January 2015 and April 2022. A NGS test was performed on the tumor tissue of each patient at the Laboratory of Molecular Pathology of the University Hospital of Modena. This study analyzed the clinical-pathological characteristics and mutational profile of the population using NGS tests, with a focus on actionable mutations that could be targeted in advanced stages of clinical development. The indicator of this study was to quantify the actionable mutations that resulted in a change of cancer treatment. In total, 101 patients with metastatic breast cancer were analyzed, including 86 with luminal phenotype, 10 who were HER2-positive and 5 who were triple-negative. Median age was 52 years. NGS analysis was conducted on 47 samples of primary breast cancer, 52 on metastatic sites of disease and 2 on liquid biopsies. A total of 85 gene mutations were found. The most common mutations were identified in the PIK3CA (47%), FGFR (19%) and ERBB2 genes (12%), and to a lesser extent in other genes. Of the 61 patients with pathogenic mutations, 46 (75%) had at least one actionable mutation. Of these, nine received treatment with a molecular target drug: eight patients with a mutation of the PIK3CA gene were treated with alpelisib and fulvestrant; one patient with FGFR1/2 amplifications received TAS120. Median PFS for these patients was 3.8 months. The study results show that using the NGS test on cancer tissue of metastatic breast cancer could influence the therapeutic choices, considering the small sample size and limited follow-up. About 9% of the study population had their therapy modified based on the results of NGS. The growing number of detectable mutations and increased accessibility of the test may lead to a greater number of potential therapeutic implications for the NGS assay. Perspectives suggest that NGS analysis can be implemented in daily clinical practice, particularly in contexts where a Molecular Tumor Board (MTB) is active.

DNA Methylation Profiling Enables Accurate Classification of Nonductal Primary Pancreatic Neoplasms

Background and aimsCytological and histopathological diagnosis of non-ductal pancreatic neoplasms can be challenging in daily clinical practice while it is crucial for therapy and prognosis. The cancer methylome is successfully used as a diagnostic tool in other cancer entities. Here, we investigate if methylation profiling can improve the diagnostic work-up of pancreatic neoplasms. MethodsDNA methylation data were obtained for 301 primary tumors spanning six primary pancreatic neoplasms and 20 normal pancreas controls. Neural Network, Random Forest, and XGBoost machine learning models were trained to distinguish between tumor types. Methylation data of 29 non-pancreatic neoplasms (n = 3708) were used to develop an algorithm capable of detecting neoplasms of non-pancreatic origin. ResultsAfter benchmarking three state-of-the-art machine learning models, the Random Forest model emerged as the best classifier with 96.9% accuracy. All classifications received a probability score reflecting the confidence of the prediction. Increasing the score threshold, improved the Random Forest classifier performance up to 100% with 87% of samples with scores surpassing the cutoff. Using a logistic regression model, detection of non-pancreatic neoplasms achieved an area under the curve (AUC) of > 0.99. Analysis of biopsy specimens showed concordant classification with their paired resection sample. ConclusionPancreatic neoplasms can be classified with high accuracy based on DNA methylation signatures. Additionally, non-pancreatic neoplasms are identified with near perfect precision. In summary, methylation profiling can serve as a valuable adjunct in the diagnosis of pancreatic neoplasms with minimal risk for misdiagnosis, even in the pre-operative setting.

Artificial Intelligence-Based Treatment Decisions: A New Era for NSCLC.

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality among women and men, in developed countries, despite the public health interventions including tobacco-free campaigns, screening and early detection methods, recent therapeutic advances, and ongoing intense research on novel antineoplastic modalities. Targeting oncogenic driver mutations and immune checkpoint inhibition has indeed revolutionized NSCLC treatment, yet there still remains the unmet need for robust and standardized predictive biomarkers to accurately inform clinical decisions. Artificial intelligence (AI) represents the computer-based science concerned with large datasets for complex problem-solving. Its concept has brought a paradigm shift in oncology considering its immense potential for improved diagnosis, treatment guidance, and prognosis. In this review, we present the current state of AI-driven applications on NSCLC management, with a particular focus on radiomics and pathomics, and critically discuss both the existing limitations and future directions in this field. The thoracic oncology community should not be discouraged by the likely long road of AI implementation into daily clinical practice, as its transformative impact on personalized treatment approaches is undeniable.

Iron Deficiency Anemia: The Contribution of Upper Digestive Endoscopy in Etiological Investigation

Iron-deficiency anemia is very common among patients in gastroenterology. The digestive system plays a key role in the pathophysiology of iron-deficiency. Indeed, digestive causes are one the most fequent etiology. This is why endoscopic evaluation is part of the etiological assessment of iron-deficiency anemia. The aim of this study is to investigate the usefulness of esophagogastroduodenoscopy (EGD) and histopathology in the etiological diagnosis of iron-deficiency anemias. Materials and Methods: This is a monocentric study conducted from January 2019 to December 2023. All patients with iron-deficiency anemia who underwent EGD were included. Various data were recorded, including patients' epidemiological information, laboratory findings, and results from endoscopic examinations. Results: Out of 2960 EGD, 576 (19,5%) were included in the study. The mean age of the patients was 49.81 years, ranging from 18 to 83 years. The male-to-female sex ratio was 0.67. It is notable that 47.5% of the patients had various medical histories: inflammatory bowel disease (IBD) in 19.13% of cases, history of non-steroidal anti-inflammatory drug (NSAID) use in 12.17%, coeliac disease in 6.13%, cirrhosis with portal hypertension in 8.70%. All patients underwent EGD. An abnormality was found in 63.4% of cases, including: Esophageal lesions: gastroesophageal varices in 13.3% of cases, erosive esophagitis in 7.5%, esophageal tumor in 0.6% of cases. Gastric lesions: erosive gastritis in 35% of cases, ulcerative gastritis in 22%, erythematous gastritis in 17%, gastric tumor in 15% of cases, supra-centimetric hyperplastic polyps in 5% of cases. Bulboduodenal lesions: erosive bulboduodenitis in 25% of cases, ulcerative bulboduodenitis in 18%, duodenal fold rarefaction in 16%, angiodysplasia in 3.5%. Gastric and duodenal biopsies were systematically performed. Duodenal biopsies showed a celiac disease aspect in 7.6% of cases, and nonspecific duodenitis in 4.6% of cases. Gastric biopsies revealed gastritis with Helicobacter pylori (Hp) in 57.6% of cases. Thus, the diagnostic yield of EGD was 47.33%. Conclusion: Iron deficiency anemia are common medical conditions in daily clinical practice. The multiple etiologies of iron deficiency anemia and the nonspecificity of symptoms make diagnosis difficult. Gastrointestinal lesions are frequently observed in patients with iron deficiency anemia. Digestive endoscopy has a great value in the etiological investigation of this pathology. Gastroscopy allows for the etiological diagnosis for many patients that’s why it is systematically recommended do it.

Validation of the AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting

PurposeTo evaluate feasibility, internal consistency, inter-rater reliability, and prospective validity of AO Spine CROST (Clinician Reported Outcome Spine Trauma) in the clinical setting.MethodsPatients were included from four trauma centers. Two surgeons with substantial amount of experience in spine trauma care were included from each center. Two separate questionnaires were administered at baseline, 6-months and 1-year: one to surgeons (mainly CROST) and another to patients (AO Spine PROST—Patient Reported Outcome Spine Trauma). Descriptive statistics were used to analyze patient characteristics and feasibility, Cronbach’s α for internal consistency. Inter-rater reliability through exact agreement, Kappa statistics and Intraclass Correlation Coefficient (ICC). Prospective analysis, and relationships between CROST and PROST were explored through descriptive statistics and Spearman correlations.ResultsIn total, 92 patients were included. CROST showed excellent feasibility results. Internal consistency (α = 0.58–0.70) and reliability (ICC = 0.52 and 0.55) were moderate. Mean total scores between surgeons only differed 0.2–0.9 with exact agreement 48.9–57.6%. Exact agreement per CROST item showed good results (73.9–98.9%). Kappa statistics revealed moderate agreement for most CROST items. In the prospective analysis a trend was only seen when no concerns at all were expressed by the surgeon (CROST = 0), and moderate to strong positive Spearman correlations were found between CROST at baseline and the scores at follow-up (rs = 0.41–0.64). Comparing the CROST with PROST showed no specific association, nor any Spearman correlations (rs = −0.33–0.07).ConclusionsThe AO Spine CROST showed moderate validity in a true clinical setting including patients from the daily clinical practice.