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The value of routine endoscopic ultrasound in patients with esophageal cancer undergoing active surveillance after neoadjuvant chemoradiotherapy
No full textBackground:Active surveillance for esophageal cancer after neoadjuvant chemoradiotherapy (nCRT) involves repeated diagnostic tests to detect cancer regrowth. In the SANO trial, this included esophagogastroduodenoscopy (EGD) with biopsies, endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) of suspicious lymph nodes, and fluorodeoxyglucose positron emission tomography with computed tomography (PET-CT). The value of routine EUS in this setting remains largely unknown. This study aimed to assess the diagnostic yield of EUS over PET-CT. Methods:A retrospective analysis of patients with esophageal cancer who underwent nCRT followed by clinical response evaluations with EGD, EUS, and PET-CT was performed. Initial response assessment was performed within 3 months post-nCRT. Patients without tumor regrowth underwent active surveillance with repeated diagnostic testing. The primary outcome was the rate of EUS-detected lymph node metastases missed by PET-CT, after excluding cases with positive EGD findings or distant metastases.Results: 327 patients underwent both PET-CT and EUS post-nCRT, accounting for 1006 combined procedures: 327 at initial response assessment; 679 during active surveillance (6-60 months post-nCRT) in 121 patients. Positive lymph nodes were detected by EUS in 3.7% (12/327) of initial response assessments, with 2.1% (7/327) unidentified by PET-CT. During surveillance, this dropped to 0.9% of assessments (6/679), with 0.1% (1/679) missed by PET-CT. Conclusions:EUS with FNA adds most value at 3 months post-nCRT, when the likelihood of detecting recurrence is highest. Beyond 3 months, its added value is limited (0.1% with negative PET-CT). Restricting the use of EUS to PET-suspicious nodes could omit 98% of EUS procedures.</p
The expanding H5N1 avian influenza panzootic causes high mortality of skuas in Antarctica
No full textHigh pathogenicity avian influenza virus H5N1 subtype (H5N1 HPAIV), clade 2.3.4.4b, is expanding its host and geographical range, and invaded Antarctica in 2023. Although mortality in Antarctic wildlife from H5N1 HPAIV has been suspected, mainly based on virological analysis of swabs collected from dead animals, it has not been unequivocally diagnosed. Here we show that H5N1 HPAIV caused high mortality in a breeding colony of skuas at one of ten sites in Antarctica we visited in March 2024. By combined virological, bacteriological and pathological analyses, we found that H5N1 HPAIV caused multi-organ necrosis and rapid death in skuas, but not in other species examined. Taken together with recent data, skuas in Antarctica are at risk of continued mortality from H5N1 HPAIV infection, threatening their already small populations. Conversely, because of their wide distribution and ecological relevance, skuas may play a substantial role in the spread of the virus across Antarctica. Transdisciplinary surveillance is needed in coming years to monitor the impact of this poultry-origin disease on Antarctica’s unique wildlife.</p
Eligibility for Lung Cancer Screening in Switzerland:A Comparative Analysis of Three Data Sources From Lausanne and the Canton of Vaud
No full textObjectives: This study aimed to estimate the proportion of individuals potentially eligible for lung cancer screening in Lausanne, canton of Vaud, Switzerland, and its associations with key sociodemographic and health-related covariates. Methods: We analyzed self-reported, cross-sectional data from three sources: Lausanne cohort 65+ (2014; n = 1,678; ages 65–70), CoLaus|PsyCoLaus (2014–2017; n = 3,839; ages 50–79), and the Swiss Health Survey (2022, representative of Vaud, ages 50–79). Eligibility was defined by the 2021 United States Preventive Services Task Force criteria. Screening eligibility prevalence was estimated separately in each dataset, and eligible and non-eligible participants were compared using bivariate hypothesis tests. Results: Eligibility was 18.2% in the Lc65+ cohort, 16.0% in CoLaus, and 14.4% in the Swiss Health Survey. Among eligible individuals, the prevalence of current smoking was 58.7% in Lc65+, 60.1% in the Swiss Health Survey, and 64.9% in CoLaus. Eligible participants tended to have a higher burden of comorbidities and social vulnerabilities, including cardiovascular disease, metabolic syndrome, depression, and lower education or income; statistically significant differences varied by dataset. Conclusion: In this Swiss population, about one in six adults met lung cancer screening criteria. Findings highlight the need for combining early detection with tobacco cessation, health promotion, and equitable access to care.</p
MDS/AML and AML with myelodysplasia-related gene mutations:clinical and molecular similarities
No full textAcute myeloid leukemia (AML) is driven by diverse genetic abnormalities. We investigated clinical and molecular differences between clinically defined secondary AML following antecedent MDS, molecularly defined secondary type AML (st-AML), molecularly defined MDS/AML (st-MDS/AML; 10%-19% blasts) and other newly diagnosed AML (de novo AML). We also examined the prognostic value of molecular measurable residual disease (MRD) in st-AML. This retrospective cohort study included 2684 intensively treated patients with AML. Diagnostic (n = 2684) and complete remission (CR; n = 436) samples were sequenced using a 54-gene panel targeting frequently mutated genes in AML. Odds ratios were calculated to show the association between mutated genes and clinically defined sAML or de novo AML. Clinical outcomes of interest were overall survival (OS) and cumulative incidence of relapse (CIR). Not only the established mutations in ASXL1, BCOR, EZH2, SF3B1, SRSF2, STAG2, U2AF1 and ZRSR2 but also ETV6 was significantly associated with clinically defined sAML, which defined the molecular signature for st-MDS/AML and st-AML. No OS differences were observed between st-MDS/AML and st-AML. Molecularly defined st-AML, now combined with st-MDS/AML, had worse OS compared with ELN2022 favorable- (5-year OS 39.9% vs 70.4%; P < .001) and intermediate-risk (5-year OS 39.9% vs 48.9%; P = .005) patients with AML. MRD based solely on secondary type mutations lacked predictive value, whereas MRD of non-DTA mutations in CR was associated with increased CIR in st-AML (subdistribution hazard ratio [SHR] 3.25; P < .001). Molecularly defined st-AML, including st-MDS/AML, defines a distinct AML category with a unique genetic, clinical and treatment response profile, in which next-generation sequencing (NGS)-based MRD holds markedly prognostic significance.</p
Prognostic relevance of limit of quantification as low-level cutoff for flow cytometry-based measurable residual disease assessment in acute myeloid leukemia
No full textWatershed functional lung space:a pendelluft-aware EIT segmentation method
No full textObjective:Pendelluft is the movement of air between lung regions, which results in an apparent phase-shift of the aeration curve between lung regions. Electrical impedance tomography (EIT) can be used to detect and quantify pendelluft at the bedside. A common method to select the functional lung space (FLS)-i.e. the pixels associated with ventilation-is applying a threshold to the pixel tidal impedance variation (TIV). Due to the apparent phase shift, pixel TIV is lower in regions associated with pendelluft, resulting in removal of those pixels for further analysis.Approach:We developed a novel method for FLS selection using the established watershed segmentation method. Watershed regions are segmented based on the pixel amplitude map and local peaks in that map. Watershed regions whose local peaks fall inside the threshold-based TIV FLS are included. Pixels with an amplitude above the threshold that are inside the included watershed regions form the Watershed FLS.Main results:We evaluated the algorithm in 11 patients switching from controlled mechanical ventilation (CMV) to assisted mechanical ventilation (AMV). No significant differences were found between TIV FLS and Watershed FLS during CMV. Switching from CMV to AMV lead to a significant decrease of the TIV FLS (p= 0.043), but not the Watershed FLS. As a result, TIV FLS was significantly smaller than Watershed FLS during AMV (p⩽ 0.001). Pendelluft magnitude was higher using the Watershed FLS compared to the TIV FLS during AMV (p⩽ 0.001).Significance:The common TIV-based FLS can result in the unintended removal of pendelluft-associated pixels for further analysis. The Watershed FLS includes these pixels, potentially improving the quality of EIT-analysis in patients with spontaneous breathing efforts.</p
Assessing parental concerns in developmental dysplasia of the hip in early infancy:Validation of the Dutch Hip Worries Inventory
No full textPURPOSE: The Hip Worries Inventory (HWI) is an 11-item questionnaire developed to assess parental concerns related to developmental dysplasia of the hip (DDH) in early infancy. This study aimed to translate the HWI into Dutch and evaluate its psychometric properties.METHODS: The HWI was translated using a standardized forward-backward translation process. Psychometric evaluation followed COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and included assessments of readability, interpretability, responsiveness, reliability and content validity. Parents of infants aged 3-13 months diagnosed with DDH and managed with active surveillance or abduction bracing with a Pavlik harness were included.RESULTS: The Dutch version of the HWI was completed by 59 parents prior to treatment and by 50 of them during treatment. In addition, 56 parents completed the questionnaire twice around their child's first birthday. The Dutch HWI demonstrated good readability (Flesch Reading Ease Score = 84.1) and adequate interpretability (mean score 21.53, standard deviation 6.11). Responsiveness was supported by confirmation of 89% of the predefined hypotheses. Internal consistency was good (Cronbach's α = 0.77-0.79) and test-retest reliability was excellent (Intraclass Correlation Coefficient = 0.95; 95% Confidence interval 0.91-0.97). Content validity assessment identified concerns regarding the relevance of items 3-6 for non-brace treatment, the sequencing of items, the use of negatively worded items and the absence of items addressing practical and informational needs.CONCLUSIONS: The Dutch HWI is a promising instrument for assessing parental concerns related to DDH in early infancy. However, limitations in content validity highlight the need for refinement, incorporating input from parents, caregivers and healthcare professionals to enhance content validity and clinical applicability.</p
Impressionism:The History of a Label, 1874-1974
No full textImpressionism is everywhere. Works by artists associated with the movement areused to decorate waiting rooms in doctor’s offices, in the designs of coasters, biscuit boxes and other paraphernalia, for museum marketing on posters spread throughout cities and on social media, to sell cruises on the Seine, or in movies like the 1995 romantic comedy Clueless, in which a friend’s love rival is described by the movie’s heroine Cher as a “full-on Monet” for, just like his paintings, the rival is OK from far away, while “up close, it’s a big old mess.” Impressionism’s dissemination is not only limited to its art and artists, though; the label ‘Impressionism’ is everywhere too: in titles of exhibitions,the names of auction house departments, chapters in art history books, or in the lyrics of a Taylor Swift song. It is a market category; it is a much-loved art movement, an umbrella term for artists working in a similar style around the same period, a brand name, a label used to guide museumgoers’ expectations when attending exhibitions, or a way to position artists (art) historically. Because of this omnipresence, Impressionism appears to be part of the status quo; of the cultural and aesthetic framework that shapes our daily lives, and it is known to sell
Longitudinal relations between exposure to YouTube influencer videos and Dutch teenagers’ materialism and advertised product desire
No full textThe popularity of influencer content on social media has made parents and caretakers concerned about the potential effects it may have on their children. They recognize that their children look up to influencers and feel closely connected to them, as well as that these influencers seem to induce a desire for the products and wealth on display. The presumed causality between children’s consumption of YouTube influencer videos, wishful identification, parasocial relation, advertised product desire, and materialism, however, had not been investigated prior to this study. We collected two-wave survey panel data among 218 12- to 15-year-olds to examine media effects and processes by zooming in on the cross-lagged relations between the aforementioned variables. Our findings reveal that children’s consumption of YouTube influencer videos increases advertised product desire three months later. Interestingly, rather than being affected by it, materialism predicts and increases children’s consumption of YouTube influencer videos, as well as advertised product desire and wishful identification. Finally, children’s perceived parasocial relation also drives the consumption of YouTube influencer videos. Hence, certain presumed media and process variables may, in fact, function as media selection variables, providing an alternative explanation for the positive correlations found cross-sectionally.</p
Krisanaklan Reduces Intestinal Anion and Fluid Secretion Through Inhibition of Na <sup>+</sup> /K <sup>+</sup> ‐ATPase and K <sup>+</sup> Channel Activity
No full textKrisanaklan (KK) is a traditional herbal remedy used to treat an array of gastrointestinal complaints, including infectious, secretory diarrhea (SD). We assessed the effect of KK on anion and fluid secretion across intestinal epithelia, and delineated its mode of action. KK inhibited cholera toxin/cAMP-dependent anion secretion across intestinal epithelial monolayers and native intestinal epithelium ex vivo. Similarly, KK reduced cAMP-dependent fluid secretion in intestinal organoids. KK inhibited Na+,K+-ATPase (NKA)-mediated, ouabain-sensitive ion transport and channel-mediated K+ efflux across the basolateral plasma membrane but did not block cAMP-dependent anion transport across the apical plasma membrane. KK also inhibited ouabain-insensitive ATPase activity, but did not affect cAMP-dependent protein phosphorylation. KK reduced carrier-mediated amino acid uptake in Caco-2 cells and Na+-coupled glucose transport in porcine intestine. Further, KK inhibited cGMP- and Ca2+-linked anion secretion across intestinal epithelial monolayers. We conclude that KK blocks intestinal epithelial anion and fluid secretion by inhibition of the NKA and K+ channels. Consequently, KK may ameliorate SD caused by enteric microbial pathogens. However, by inhibiting the activity of Na+-dependent solute carriers, it is also predicted to counteract oral rehydration therapy, the current mainstay for SD therapy