Systemic Signs Research Articles

Rezafungin versus caspofungin for patients with candidaemia or invasive candidiasis in the intensive care unit: pooled analyses of the ReSTORE and STRIVE randomised trials

BackgroundRezafungin is an echinocandin approved in the US and EU to treat candidaemia and/or invasive candidiasis. This post-hoc, pooled analysis of the Phase 2 STRIVE and Phase 3 ReSTORE trials assessed rezafungin versus caspofungin in patients with candidaemia and/or invasive candidiasis (IC) in the intensive care unit (ICU) at randomisation.MethodsSTRIVE and ReSTORE were randomised double-blind trials in adults with systemic signs and mycological confirmation of candidaemia and/or IC in blood or a normally sterile site ≤ 96 h before randomisation. Data were pooled for patients in the ICU at randomisation who received intravenous rezafungin (400 mg loading dose then 200 mg once weekly) or caspofungin (70 mg loading dose then 50 mg once daily) for ≤ 4 weeks. Outcomes were Day 30 all-cause mortality (primary outcome), Day 5 and 14 mycological eradication, time to negative blood culture, mortality attributable to candidaemia/invasive candidiasis, safety, and pharmacokinetics.ResultsOf 294 patients in STRIVE/ReSTORE, 113 were in the ICU at randomisation (rezafungin n = 46; caspofungin n = 67). At baseline, ~ 30% of patients in each group had impaired renal function and/or an Acute Physiologic Assessment and Chronic Health Evaluation II score ≥ 20. One patient (in the caspofungin group) was neutropenic at baseline. Day 30 all-cause mortality was 34.8% for rezafungin versus 25.4% for caspofungin. Day 5 and 14 mycological eradication was 78.3% and 71.7% for rezafungin versus 59.7% and 65.7% for caspofungin, respectively. Median time to negative blood culture was 18 (interquartile range, 12.6–43.0) versus 38 (interquartile range, 15.9–211.3) h for rezafungin versus caspofungin (stratified log-rank P = 0.001; nominal, not adjusted for multiplicity). Candidaemia/IC-attributable deaths occurred in two rezafungin patients versus one caspofungin patient. Safety profiles were similar between groups. Overall, 17.4% (rezafungin) versus 29.9% (caspofungin) of patients discontinued due to treatment-emergent adverse events. Rezafungin exposure following the initial 400-mg dose was comparable between patients in the ICU at randomisation (n = 50) and non-ICU patients (n = 117).ConclusionsRezafungin was well tolerated and efficacious in critically ill, mainly non-neutropenic patients with candidaemia and/or IC. This analysis provides additional insights into the efficacy and safety of rezafungin in the ICU population.

The role of root systems of Pinus sylvestris L. during the formation of secondary pine forests in deforestation in the Kola North

The role of the roots and root systems of Pinus sylvestris L. in the formation of secondary pine forests in the cuttings of the Kola North was studied. It has been established that in pine seedlings in disturbed areas, root and shoot systems are formed quite quickly. Already in the I-th grade of age, characteristic morphological signs of root systems appear, the feeding areas of trees begin to overlap each other. The bulk of the roots (80–85%) is concentrated in the upper 20-centimeter soil layer. A linear relationship between the taxation indicators of trees and the mass of root systems has been revealed. The conducted studies have shown that the formation of forest communities of Scots pine in the cuttings of the Kola North, their stability and productivity are directly dependent on the degree of development of individual roots and root systems as a whole.

New-onset complement-mediated thrombotic microangiopathy during the COVID-19 pandemic.

The coronavirus disease-19 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus is alleged to enable a proinflammatory state, that leads to the activation of the coagulation and the complement cascade. In this study, we aimed to establish the impact of the COVID-19 pandemic on patients with new onset of cTMA/aHUS in the Vienna TMA cohort and whether COVID-19 or SARS-CoV-2 vaccinations would pose a greater risk of initial manifestation of cTMA/aHUS. We used the Vienna TMA cohort database to examine the prevalence of COVID-19 related and of SARS-CoV-2 vaccination-related aHUS/cTMA during the first 3 years of the COVID-19 pandemic in a large single-center cohort. Between March 2020 and May 2023, a total of 7 patients experienced their first aHUS/cTMA episode. No patient experienced a TMA relapse or more than one episode during the follow-up period. Three TMA episodes were attributable to either COVID-19 (n=1; 33%) or SARS-CoV-2 vaccination (n=2; 66%), respectively. All three patients had systemic signs of TMA and TMA was confirmed by kidney biopsy in all cases. Among the seven patients we recorded five infections that triggered one TMA episode (20%) and 19 vaccinations triggered two TMA episodes (10%; p=0.52, odds ratio 0.47; 95% CI 0.04-8.39). We speculate, that both SARS-CoV-2 vaccinations and COVID-19 episodes can represent a triggering factor for aHUS/cTMA episodes in (genetically) vulnerable individuals. However, COVID-19 might have a stronger association and might be a stronger trigger than the SARS-CoV-2 vaccines. The incidence of new aHUS cases did not differ from the pre-pandemic era in a large tertiary care centre cohort.

Myopia and systemic manifestation of tissue hyperlaxity: A population-based cross-sectional study.

Whether non-syndromic connective tissue hyperlaxity is associated with myopia is unknown. The aim of this study was to examine the association between systemic signs of tissue hyperlaxity and myopia among adolescents. Included were adolescents assessed before mandatory military service at the age of 16-18 years between 2011 and 2022. Diagnoses of hernias, pes planus, genu varus, genu valgum, and scoliosis, as well as joint injuries were used as surrogate markers for tissue hyperlaxity. The prevalence of these events among adolescents with myopia was evaluated and compared to the non-myopic population. Included were 920 806 adolescents. The mean age was 17.4 ± 1.4 years and 58.6% were men. Myopia was diagnosed in 290 759 adolescents (31.6%) and high myopia in 24 069 adolescents (2.6%). The prevalence of hernias was higher among adolescents with myopia, (2.76%, 95% confidence interval (95% CI): 2.69%-2.82% vs. 2.60%, 95% CI: 2.57%-2.65%), as were pes planus (14.92%, 95% CI: 14.79-15.05 vs. 13.51%, 95% CI: 13.42-13.59) and scoliosis (9.14%, 95% CI: 9.03-9.24 vs. 7.69%, 95%CI: 7.62-7.76). The prevalence of joint injuries was clinically similar between groups (less than 0.1% difference for ankle, shoulder, and knee injuries), as were genu varum and genu valgum (0.66%, 95%CI: 0.64%-0.69% vs. 0.68%, 95% CI: 0.66-0.70, respectively). Adjusted for possible confounders results remained consistent. Among a large sample of Israeli adolescents, those with myopia had a higher prevalence of hernias, pes planus, and scoliosis. These results could suggest a propensity for systemic conditions related to tissue laxity among myopic adolescents.

The effects of the traffic signs information volume on the visual characteristics and workload of novice and experienced drivers.

The effects of traffic sign information volume (TSIV) on the visual characteristics and workload of novice and experienced drivers were investigated in this study. TSIV plays a crucial role in road traffic safety, and understanding its impact on drivers is essential for designing effective traffic sign systems. This research aimed to compare the visual characteristics and workload of novice and experienced drivers under varying TSIV doses through simulated driving tests. The objective was to provide insights for optimizing the design of road TSIV. Six TSIV levels were considered: S0, S1, S2, S3, S4, and S5, representing different workload levels. Participants, including both novice and experienced drivers, were involved in simulated driving scenarios with varying TSIV levels. Eye movement data was collected using an eye tracker device. The study was conducted in China, and appropriate driving simulators and equipment were utilized. The findings revealed several valuable results. Experienced drivers exhibited a higher proportion of saccade behavior in the 30-90 ms time period and did not show rapid saccade behavior during the 0-30 ms period, indicating superior visual search strategies. Both novice and experienced drivers demonstrated improved visual cognitive abilities at the S3 level of TSIV, which corresponds to normal and safe driving conditions. Furthermore, a majority of both groups had saccade amplitudes in the range of 0°-4°, with experienced drivers showing a slightly higher proportion. About 82% of experienced drivers had saccade behavior within the range of 0°-2°, compared to 75% of novice drivers. The study concludes that the S3 level of TSIV, corresponding to 30 bits/km, is optimal for both novice and experienced drivers. This level promotes better visual performance and reduces visual workload, indicating that drivers' information acquisition capacity and visual search strategies are maximized while keeping the workload associated with driving at a minimum. These findings have significant implications for enhancing driving safety.

Yeni ‘Film’ veya ‘Sinema’ Tarihi: Sinema Tarihi Yazımında Yeni Gelişen İlkeler, Kuramlar ve Metodolojiler Üzerine Düşünceler

Film as an artefact has long been the subject of study by “film historians,” whether in terms of stylistic authenticity, genre specificity, or “high theory” analysis. Conversely, film history has been written as if films had no audiences (Biltereyst et al, 2012, p. 693). This kind of filmic-textual research tendency lies at the heart of the legacy of film studies discipline. In 1973, Jean Mitry proposed an ideal of film history as simultaneously, a history of its industry, its technologies, its systems of expression (or, more precisely, its systems of signification), and aesthetic structures, all bound together by the forces of the economic, psychosocial and cultural order (Maltby, 2006, p. 80). Humanities-based film studies were first re-conceptualized by the initiatives of International Federation of Film Archives (FIAF), during its 1974 and 1978 conferences. Drawing on the methodological stance of the French Annales school’s histoire totale, participants at the 1974 FIAF conference agreed on new historiographical methodologies for all rather than linear national cinema histories. In 1990, American historian Robert Sklar brought forward three types of “cinema historians” in which only second sub-type might be labeled as ‘film historian’ which has been emerged from one of the following disciplines: art history, philosophy, literary studies.

Frege’s Begriffsschrift: On the Visual Basis of Logical Articulation and Understanding

One of Gottlob Frege’s most original contributions to logic and philosophy was his logical notation, his ‘Begriffsschrift’. While long criticized, dismissed, or simply ignored, the recent secondary literature contains some helpful re-evaluations and partial defenses of it. These rely largely on technical, pragmatic, or cognitive-psychological considerations. In this paper, we reconsider Frege’s own reasons for valuing his notation highly. We argue that there is a further semiotic dimension, one that matters epistemologically. This dimension becomes evident once one takes seriously, partly also literally, some striking visual metaphors Frege uses. The result is an interpretation highlighting a side of Frege’s position that is not widely known. It involves his views about the indispensable role that language, or sign systems more generally, play for human thought, and especially, for logic and mathematics. More particularly and as we read Frege, a good logical notation allows for expressing conceptual/inferential relations in a ‘visually inscribed’, thus ‘perspicuous’ way, and this leads to a special kind of ‘insight’ in mathematics. Or as we elaborate this point further, it involves a kind of articulation and understanding hardly possible without it. Frege designed his Begriffsschrift with that specific goal in mind.

Kurdish Sign Language Recognition Using Convolutional Neural Network (CNN)

The present study examines the obstacles encountered by the deaf population, with a specific emphasis on the increasing significance of sign language in facilitating effective communication. The main mode of communication for deaf persons is Sign Language (SL), which is a visual and expressive method of communicating meaning via facial expressions, hand motions, and body gestures. The objective of this project is to automate the identification of sign language in order to improve accessibility and decrease reliance on interpreters. Specifically, the work focused on constructing an alphabet recognition system for Kurdish Sign Language (KSL). Due to its many intricacies and resemblances to the Arabic script, KSL requires a strong recognition model. The proposed method utilizes Convolutional Neural Networks (CNN) with an actual dataset to accurately recognize both numerical values and alphabetic characters in the Korean Sign Language (KSL). Real-time operation allows for rapid recognition of hand gestures and subsequent provision of textual output. The collection comprises 132,000 hand pictures, including 33 alphabetica and (0-9) numeral signs. Significantly, the use of MediaPipe, a method for processing 3D images, greatly improves the efficiency of detection. Multiple methodologies were investigated, and the integration of Convolutional Neural Networks (CNN), TensorFlow, and MediaPipe resulted in a remarkable accuracy of 99.87% with negligible dropout rates. This study establishes a foundation for enhanced communication and independence for the deaf population, representing a notable advancement in the automation of sign language recognition.

Appropriateness of antibiotic prescribing among patients treated for dental diseases in Mekelle city, Northern Ethiopia: a cross sectional study

BackgroundLocal operative treatments are generally preferred for most dental diseases, with antibiotics only recommended as an adjunct in specific cases. Misuse and overuse of antibiotics has been shown to significantly contribute to the development of resistant bacteria. However, the antibiotic prescribing practices of dentists in Ethiopia have not been thoroughly studied. This study aimed to assess the appropriateness of antibiotic prescribing for patients with dental diseases at dental clinics in Mekelle City, Northern Ethiopia.MethodsA cross sectional study was conducted in April and May 2020 among patients visiting dental clinics in Mekelle City. Data were collected through patient medical record reviews and dentist interviews. The appropriateness of antibiotic prescription was evaluated based on guidelines from the American Dental Association and the European Society of Endodontology. Data were analyzed using SPSS Statistics, version 29. Binary logistic regression analysis was performed, and the results were presented as odds ratios with 95% confidence intervals. A p value less than 0.05 was considered statistically significant.ResultsTwo hundred and thirty-one patients with dental diseases participated in the study. The mean age was 30.6 years with a standard deviation of 16.1. Most participants had dental pulp related disease. 89% of patients were prescribed antibiotics, with amoxicillin being the most common. Inappropriate antibiotic prescribing was identified in 175 (75.8%) of the study participants. The most common inappropriate prescribing was unnecessary antibiotic prescribing for dental conditions without systemic signs, assessed in 141 (80.1%) participants. Patients diagnosed with pulp related disease without systemic signs and those who had tooth extractions were significantly associated with inappropriate antibiotic prescription (p value < 0.001).ConclusionsThe study findings show that antibiotics are over-prescribed for dental conditions in this resource constrained setting, especially in patients who have had tooth extractions. Dentists need training on appropriate antibiotic use and antimicrobial stewardship interventions should be implemented in dental setting to reduce unnecessary antibiotic prescriptions and prevent antibiotic resistance development.

Analysis of Guidance Signage Systems from a Complex Network Theory Perspective: A Case Study in Subway Stations

Analysis of Guidance Signage Systems from a Complex Network Theory Perspective: A Case Study in Subway Stations

A multi-lingual sign language recognition system using machine learning

AbstractRecently, automatic sign language recognition field gets a great attention. Machine learning algorithms are mainly used to recognize hand gestures. Most of recent studies train their machine learning model using a specific sign language of a specific country such as the American Sign Language. In this paper, we propose a multi-lingual sign language system based machine learning that is called Multi-lingual Sign Languages Interpreter (MSLI) system. MSLI trains a machine learning model based on hand signs of multiple languages. It can detect the language of the input signs and their labels. In a case of input testing signs with the same language, the proposed system can provide two-steps recognition, where it only detects the language of the first sign, and then the rest signs are tested according to the recognized language. Also, MSLI can provide separate classification of signs per each language. Experiments were performed using 11 datasets with different languages. Separate and combined classification was performed on the input data. Experimental results show the accuracy of the proposed system. Training accuracy of the proposed system over most of the used separate different sign language datasets is approximately ranged from 90 to 100%. Also, most classification accuracy results of the test data of the separate datasets exceeded 90%. The combined classification of proposed MSLI archived training accuracy of 95.87% and testing accuracy of 92.33%.

Communication in the Mirror of Social Semiotics

Introduction. The subject of this article is communicative resources, which are selected by partners from a huge variety of linguistic means, functional styles, rhetorical techniques, and subject activities, and through which a common semantic space between individuals is generated.Methodology and sources. As a methodological platform we propose the principles of praxis-oriented social semiotics. Being one of the relatively late trends of semiotic research, social semiotics focuses attention not so much on signs or sign systems as on social signifying practices as regular, repetitive, recognisable types of actions: the actions of communication participants are endowed with the properties of sign systems through which relations between individuals are discovered, made visible and meaningful. The mechanisms of meaning production, from the point of view of the participants of the event, are analysed using the concept of ‘discursive practices’, understood as speech actions in order to solve a variety of practical interpersonal tasks.Results and discussion. As an individual learns a variety of interpersonal discursive practices, different relational systems become available to him/her. Specific discursive practices allow individuals to present different versions of their self, justify their actions, maintain dominance and/or subordination relations, thus demonstrating mastery of the communicative situation. Following the principles of praxis-oriented social semiotics, it can be argued that interpersonal relationships involve what can be called a discourse of trust, personal involvement in relationships, intimacy/closeness.Conclusion. The described symbolic regulators allow not only to semiotically comprehend the social positions of interacting parties, but also to offer self-control procedures and an arsenal of communicative actions to the participants of interpersonal communication as means of behaviour management in situations of interpersonal communication.

S-Adenosylmethionine (SAMe) for Central Nervous System Health: A Systematic Review.

Background/Objectives: S-adenosylmethionine (SAMe) is a natural compound used to improve mood-related symptoms. Our aim was to determine the efficacy, safety, and optimal dose of SAMe in Central Nervous System (CNS) signs (e.g., mood, behavior). Methods: We conducted a PRISMA-based systematic review by searching PubMed, CINAHL, and Web of Science using MeSH search terms. Articles were independently reviewed by two researchers (with a third resolving conflicts) during title/abstract screening and full-text review. Data were extracted in the same approach, with a quality assessment of included articles. Results: Out of 1881 non-duplicated studies, 36 were included in the review focusing on CNS signs (mood, behavior, sleep). Most studies (n = 32) achieved a 4 or 5 out of 5 points, indicating high study quality. Overall, SAMe was effective in 24 of 36 studies, with adverse events mostly consisting of mild, transient gastrointestinal disturbances. Conclusions: Many patients in these studies did experience improvements in CNS signs from using SAMe alone or in combination with existing therapy. However, future studies are needed to further understand the long-term effects of SAMe in the CNS.

Investigating the Satisfaction of Residents in the Historic Center of Macau and the Characteristics of the Townscape: A Decision Tree Approach to Machine Learning

The historic city of Macau is China’s 31st world heritage site, and its residents have actively contributed to preserving its heritage and will continue to reside there for the foreseeable future. Residents’ satisfaction with the current urban environment is closely related to the landscape characteristics of the towns surrounding the historic center of Macau. This study aims to analyze the relationship between landscape characteristics and residents’ satisfaction, determine the key factors affecting their satisfaction and how they are combined, and provide a scientific basis for urban planning. This study used a decision tree machine learning model to analyze 524 questionnaire survey responses that addressed five aspects of the historic town’s landscape: the architectural, Largo Square, street, mountain and sea, and commercial landscapes. The data-driven approach helped find the best decision path. The results indicate that (1) the layout of Largo Square, the commercial colors and materials, the location of the former humanities and religion center, and the commercial signage system are the primary factors influencing residents’ satisfaction. (2) Incorporating decision tree parameters with information entropy as the splitting criterion and a minimum sample split number of two (with no maximum depth) led to the best performance when investigating residents’ satisfaction with Macau’s historic town landscape characteristics. (3) A reasonable layout for Largo Square (satisfaction &gt; 3.50), prominent and harmonious commercial colors and materials (satisfaction &gt; 3.50), rich cultural and religious elements (satisfaction &gt; 4.50), and an excellent commercial signage system (satisfaction &gt; 4.00) can significantly improve residents’ satisfaction. This provides important empirical support and a reference for urban planning and landscape design in Macau and other historical and cultural cities.

General loss of proteostasis links Huntington disease to Cockayne syndrome

Cockayne syndrome (CS) is an autosomal recessive disorder of developmental delay, multiple organ system degeneration and signs of premature ageing. We show here, using the RNA-seq data from two CS mutant cell lines, that the CS key transcriptional signature displays significant enrichment of neurodegeneration terms, including genes relevant in Huntington disease (HD). By using deep learning approaches and two published RNA-Seq datasets, the CS transcriptional signature highly significantly classified and predicted HD and control samples. Neurodegeneration is one hallmark of CS disease, and fibroblasts from CS patients with different causative mutations display disturbed ribosomal biogenesis and a consecutive loss of protein homeostasis - proteostasis. Encouraged by the transcriptomic data, we asked whether this pathomechanism is also active in HD. In different HD cell-culture models, we showed that mutant Huntingtin impacts ribosomal biogenesis and function. This led to an error-prone protein synthesis and, as shown in different mouse models and human tissue, whole proteome instability, and a general loss of proteostasis.

Expressive sign language system for deaf kids with MPEG-4 approach of virtual human character

Expressive sign language system for deaf kids with MPEG-4 approach of virtual human character

KAJIAN PERENCANAAN PASAR INDUK KABUPATEN BADUNG DENGAN PENDEKATAN TATA RUANG, ARSITEKTUR, DAN BUDAYA LOKAL BALI

In the central market planning project in Badung Regency, Bali, the main objective was to develop an economic center that combines cultural elements with sustainable economic growth. The planning goes beyond the traditional paradigm of development by integrating cultural, social, environmental, architectural, civil engineering and economic factors, creating an entity that carries more value than just commercial transactions. The central market is intended to represent a balance between cultural heritage and the dynamics of modernity, with reference to the principles of Tri Hita Karana (balance with God, fellow humans, and the natural environment) as well as the concept of Hulu - Teben which directs the organization of space based on the flow of the river. The Tri Mandala and Sanga Mandala concepts guide the zone mapping and building orientation, optimizing air circulation and natural lighting. The market architecture adopts traditional Balinese elements such as limasan and jineng roof forms, and utilizes natural materials such as red bricks and temple stones. A purposeful and iconic signage system, including the Ratu Niang Sakti statue, became an important part of the design. The result is a synergy between cultural values and global progress, forming a neighborhood that functions not only as a place of transaction, but also as a vehicle for cultural preservation and a driver of inclusive economic growth. The project encourages active community participation in the development process, accelerates the welfare of local communities, and improves the competitiveness of the region. Thus, the project achieves its goal not only as physical infrastructure, but also as a platform that integrates cultural significance and economic dynamism within the framework of sustainable development

Insights into the Virulence and Antimicrobial Resistance of Staphylococcus hyicus Isolates from Spanish Swine Farms.

Staphylococcus hyicus is a significant pathogen in swine, primarily causing exudative epidermitis. Addressing S. hyicus infections requires both the characterization of virulence and antimicrobial resistance (AMR) in farm-recovered isolates. This study aimed to characterize the virulence, AMR, and biofilm formation of S. hyicus isolates from Spanish swine farms. A total of 49 isolates were analyzed, originating from animals with cutaneous, reproductive, and systemic clinical signs. Half of the isolates (49.0%) were positive for at least one virulence factor (VF) gene, with SHETA being the most frequent (28.6%). A high frequency of multidrug resistant (MDR) isolates was observed (83.7%), with significant resistance to commonly used antimicrobials, including lincosamides (83.7%), pleuromutilins (81.6%), penicillins (75.5%), and tetracyclines (73.5%). All isolates exhibited robust in vitro biofilm formation capacity (DC = 15.6 ± 7.0). Significant associations were found between VFs, biofilm formation, and AMR patterns, highlighting the link between the resistance to lincosamides and pleuromutilins (p < 0.001; Φ = 0.57) and macrolides (p < 0.001; Φ = 0.48), and the association of AMR with the ExhC and ExhD VF genes. These findings underscore the need for targeted diagnostics to improve management and therapeutic strategies to mitigate the impact of S. hyicus on swine production.

ThP3.3 - Prophylactic Endoluminal Vacuum Therapy – towards an era of reducing leak related morbidity after elective oesophago-gastric resection

Abstract Aims Uncontrolled sepsis following leak from oesophago-gastric surgery is a devastating condition with increased morbidity &amp; mortality affecting longer-term cancer-free survival in patients with cancer resections. We hypothesised that endoluminal vacuum therapy (EVT), previously used to treat leaks, could be used in prophylactic settings to provide source-control, prevent mediastinitis and minimise sepsis related morbidity from leaks. Methods An ad-hocEVT device was created using VACgranufoam (KCI)and a nasogastric-tube(16/18Fr), and placed intraluminally across the repair/anastomosis in select high-risk cases. Continuous negative pressure(75–125mmHg) was applied. Assessment of the repair-site/anastomosis was performed by radiology, endoscopy, clinical assessment or a combination following cessation of EVT. Results 27 patients had prophylactic EVT; M:F ratio was 3:1 and the median age was 68 years (range: 41-82years). 26surgeries were for cancer, while 1 was benign. The rationale for prophylactic EVT included patient related (10), technical factors (16) or both (1). The median duration of prophylactic EVT was 7 days (range: 4-14days). The median length-of-stay was 19.7 days (range: 6-96 days), the two longest admissions were unrelated to the anastomosis(prolonged chyle-leak, and long-term-sequelae of life-threatening bleed). One-patient developed a full-thickness microleak at endoscopic-evaluation, yet remained well with no systemic signs of sepsis, successfully managed with luminalEVT for a further 6days in a ward-based environment. Though prophylacticEVT did not prevent the leak, it significantly minimised the systemic hit that traditionally results from leak and associated mediastinal sepsis. Conclusions ProphylacticEVT is a useful adjunct for management of patients with a high risk for leak, though not a substitute for good surgical technique. There are no short-term complications, yet the additional morbidity, mortality and length-of-stay associated with a fully-fledged leak is avoided. Randomised-controlled-trials are required to further standardise selection criteria, assess potential patient benefit and longer-term impact on survivorship.

Ocular Ultrasound in the Diagnosis of Optic Neuropathies: A Review of the Literature.

Optic neuropathies represent one of the most frequent causes of vision loss, and they can manifest alone or in conjunction with neurological or systemic symptoms and signs. In recent years, the diagnostic techniques used to detect optic neuropathies have significantly improved, facilitating diagnosis and improving treatment. Among these, ocular ultrasound has assumed a fundamental role, although with conflicting results in the published scientific literature. For this reason, the aim of this review is to analyze the role of ocular ultrasound in the precise and targeted diagnosis of optic neuropathies to better understand the presumed potential of this precious diagnostic tool in the management of these ocular and neurological disorders. We carried out a search on PubMed and Scopus utilizing terms related to optic neuropathies and ocular ultrasound, including only relevant English full-length research articles, case reports, or case series. Most of the papers published in the scientific literature use only the B-scan ultrasound technique without considering the more precise and objective standardized A-scan technique that allows for performing more accurate diagnostic tests, such as the "30-degree test" and the "optic nerve exercise test". Future clinical trials and research on optic neuropathies should also consider the use of the standardized A-scan technique in order to compare clinical findings not only with B-scan ultrasonography but also with other noninvasive procedures that could be helpful in reaching the correct diagnosis.