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Atypical Single PML::RARA Fusion in Acute Promyelocytic Leukemia - Mechanisms and Clinical Implications
No full textClinical Features and Treatment Outcomes of Patients with Tubulointerstitial Nephritis and Uveitis Syndrome: A Case Series
No full textDescribe the demographic and clinical characteristics, treatment outcomes, and ocular complications in patients with tubulointerstitial nephritis and uveitis (TINU) syndrome.
Retrospective study of TINU patients seen at the Foster Center for Ocular Immunology (Duke University) and Wilmer Eye Institute (Johns Hopkins School of Medicine) between January 2014-December 2023. Patients were diagnosed using the 2021 SUN Working Group criteria.
27 TINU patients, 16 (59%) males, aged 20.4 ± 15.8 (range: 7-71) years were included. The mean follow-up time was 24.3 ± 16.5 (range: 7-75) months. All tested patients had an elevated urinary β2-microglobulin. Ten (37%) patients had positive renal biopsy. Thirteen (48%) patients presented with isolated anterior uveitis, and 14 (52%) had additional intermediate/posterior segment findings in at least one eye. At baseline, all patients were managed with topical corticosteroids (TCS), with 6 (27%) patients requiring oral prednisone (PRD) and 17 (63%) steroid-sparing immunosuppressive therapy (SS-IMT). Inflammatory control was achieved in 26 (96%) patients with TCS only (
= 4), TCS+PRD (
= 5), TCS+SS-IMT (
= 6), and TCS+PRD+SS-IMT (
= 11). Thirteen of 26 patients (50%) developed disease relapse at a mean time of 8.9 ± 18.9 (range: 1-71) months. One patient was lost to follow-up. Eighteen (67%) patients developed TINU-associated ocular complications. Five eyes from 4 patients had a median decrease in visual acuity of 2 Snellen lines (range: 1-4) during follow-up.
The demographic and clinical presentation of TINU is heterogeneous. Intermediate and posterior segment manifestations are common. Treatment with topical and systemic corticosteroids only may be insufficient to prevent disease relapse, with most patients requiring long-term immunosuppressive therapy
IDSA 2025 Guidelines on the use of vaccines for the prevention of seasonal COVID-19, Influenza, and RSV infections in immunocompromised patients
No full textRespiratory viruses-including SARS-CoV-2 (COVID-19), Respiratory Syncytial Virus (RSV), and Influenza-pose significant risks to immunocompromised patients, who experience attenuated vaccine responses and higher morbidity. To address evolving vaccine recommendations for the 2025-2026 season, the Infectious Diseases Society of America (IDSA), in collaboration with the Vaccine Integrity Project (VIP) and partner organizations, developed rapid guidelines for U.S.-licensed vaccines targeting these viruses. The guideline applies to adults and children with compromised immunity due to hematologic malignancy, solid organ or hematopoietic cell transplantation, autoimmune disease on immunosuppressants, HIV with severe immunosuppression, and similar conditions. Strong recommendations, supported by moderate-certainty evidence, endorse timely administration of age-appropriate COVID-19, RSV, and Influenza vaccines, with guidance on optimal timing relative to immunosuppressive therapy and transplantation. Co-administration of these vaccines is considered appropriate. Research gaps remain in immunogenicity, durability, and clinical effectiveness, particularly for patients receiving B-cell-depleting therapies or early post-transplant. Priority areas include defining correlates of protection, optimizing vaccine schedules, evaluating high-dose or adjuvanted formulations, and improving real-world effectiveness and safety data. Equity and access strategies are essential to ensure uptake among vulnerable populations. These guidelines aim to support evidence-based decision-making and highlight the need for harmonized, multi-virus research to inform tailored vaccination strategies for immunocompromised individuals
Vertical Tarsal Plate Buckling Following Conjunctival Mullerectomy: An Unusual Complication
No full textA 75-year-old patient presented with vertical tarsal plate buckling of both upper eyelids following a conjunctival mullerectomy. Clinical examination demonstrated significant lid laxity and lateral canthal tendon instability as well as short surgical scars on the conjunctival surface. The purported mechanism was an imbalance between the strong vertical force exerted by the resected muscle applied to a short width of tissue and the relatively weak horizontal lid stabilizing forces. This case underscores the importance of carefully considering all anatomic forces supporting eyelid dynamics prior to ptosis surgery
Symptom triad of primary cervical rhabdomyosarcomas as seen in a Nigerian tertiary hospital: A case series
No full text•Primary cervical rhabdomyosarcoma is an exceptionally rare tumor.•A symptom triad for cervical rhabdomyosarcoma: cervical mass with uterine descent, gelatinous mucoid discharge, and bleeding.•Early recognition of this triad may improve the timeliness of diagnosis and management.•Surgical resection, followed by adjuvant chemotherapy or chemo-radiotherapy, led to positive outcomes in this case series.•Multidisciplinary team management, radiologic staging and immunohistochemistry were limited, highlighting key challenges
Clinical Characteristics and Postoperative Outcomes of Bilateral Lung Transplantation for COVID-19–Induced End-Stage Pulmonary Disease: A Single-Center Experience in a High Acuity Patient Population
No full textTrial Design and Objectives for Patients With Prostate Cancer: Recommendations From the Prostate Cancer Working Group 4
No full textThe continuous development of new imaging approaches, molecular phenotyping, genetic subtypes, prognosis assessments, and effective therapies across a range of disease states has created a need to redefine terminology and best practices for clinical trial conduct in patients with advanced prostate cancer.
We convened an international expert committee of diverse working groups, the Prostate Cancer Working Group 4 (PCWG4), between 2016 and 2025. Our objective was to formulate updated criteria based on emerging evidence and clinical trial data in a biomarker context to provide guidance for clinical trial design, eligibility, and end point assessments for patients with advanced prostate cancer.
PCWG4 redefines terminology around the disease state and previous therapies in a patient-centric context and terminology focused on androgen pathway modulation. We consider imaging, with a particular focus on positron emission tomography (PET)-defined disease. New recommendations are provided for disease state terminology, defining eligibility criteria, response and delay/prevent end points, intervals for reassessments including imaging, and patient-reported outcome determination. We provide recommendations in a biomarker-based context of use for the intended indication, reflective of patient benefit for specific interventions. We emphasize the need for development of validated PET imaging and molecular and phenotypic criteria as well as trial designs to appropriately risk stratify patients, predict and assess benefit, and measure post-treatment outcomes reliably in a trial framework.
PCWG4 updates recommendations on patient and tumor characterization, therapy development, and imaging criteria and extends guidance into earlier androgen pathway modulator-naïve/sensitive disease states to reflect an evolving, heterogeneous, and diverse patient population to optimize treatment benefits for all patients
Potential Predictors of Pain and Stiffness Response Following Genicular Artery Embolization for Knee Osteoarthritis
No full textBackground/Objectives: Patient-level predictors of treatment response after genicular artery embolization (GAE) for knee osteoarthritis (OA) are poorly understood. We evaluated clinical, serum, and imaging biomarkers for their ability to predict achievement of the minimally clinically important difference (MCID) for WOMAC pain and stiffness subscales following GAE. Methods: Data from a prospective single-arm clinical trial of 25 patients who underwent GAE for symptomatic knee OA was retrospectively analyzed. Candidate predictors included sex, age, BMI, contralateral Kellgren–Lawrence (KL) scores, and baseline values for serum IL-1Ra, serum VEGF, and total bone marrow edema scores on MRI using the MOAKS methodology. The primary outcomes were the frequency of achieving the MCID in WOMAC pain and WOMAC stiffness at 1, 3, and 12 months, modeled as an ordinal outcome (0–3). Ordinal logistic regression models were constructed. Variance inflation factors (VIFs) were assessed to detect multicollinearity, and leave-one-out cross-validation was performed to evaluate model robustness. Results: All candidate predictors were successfully incorporated into regression models, with no evidence of multicollinearity by VIF analysis. Lower contralateral KL scores (OR: 0.087 [0.012–0.618], p = 0.0146) and higher BMI (OR: 1.383 [1.001–1.910], p = 0.049) were significantly associated with achievement of the MCID for WOMAC pain, although significance for BMI was borderline. Lower baseline serum IL-1Ra levels (OR: 0.122 [0.018–0.816], p = 0.030) were significantly associated with achievement of the MCID for WOMAC stiffness. The remaining clinical, serum, and imaging biomarkers were not significantly associated with MCID achievement. Conclusions: In this exploratory analysis, specific baseline clinical and serum factors were associated with achievement of clinically meaningful improvements in pain and stiffness. Analysis of larger cohorts will help clarify ideal demographic-, biomarker- and imaging-based patient selection strategies that can improve prediction of treatment response and guide clinical decision-making in GAE for knee OA
Consumer sleep technology: A position statement from the National Sleep Foundation
No full textConsumer sleep technologies are increasingly used by the public and have become common tools for their daily living. This trend presents new possibilities for innovative sleep measurement and individualized insights about improvements in sleep health and related outcomes. The National Sleep Foundation (NSF) calls for action across a range of stakeholders, including the public, healthcare providers, education and government organizations, industry, and funding agencies and organizations. Understanding the potential utility and limitations of consumer sleep technologies is an important first step. With appropriate approaches, consumer sleep technologies can present unique promise and powerful possibilities that align well with National Sleep Foundation's goal to rapidly incorporate sleep science and insights into accessible products and services
