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Evidence and Consensus-based Imaging Guidelines in Birdshot Chorioretinopathy: Multimodal Imaging in Uveitis (MUV) Taskforce Report 8
No full textPurpose: To develop consensus-based imaging guidelines for diagnosing and monitoring birdshot chorioretinopathy (BSCR). Design: Consensus-based approach guided by literature and an expert committee using a nominal group technique (NGT). Methods: An expert committee of 5 international uveitis specialists reviewed 15 well-documented representative BSCR cases with comprehensive imaging data. Cases with active and inactive disease were included. Imaging, including color fundus photography (CFP), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), optical coherence tomography (OCT), fundus autofluorescence (FAF), and OCT angiography (OCTA) were reviewed. Using a structured NGT approach, consensus-based recommendations were developed for specific disease characteristics, biomarkers of activity, and complications. The recommendations were voted upon by members of the full task force. Results: For the diagnosis of BSCR, CFP, FFA, and ICGA were identified as the key imaging modalities. ICGA was identified as a key imaging modality for assessing the presence of choroidal lesions. FFA was deemed crucial for monitoring retinal vascular leakage and assessing the treatment response. OCT, while not essential for diagnosis, was valuable for detecting complications such as cystoid macular edema and retinal thinning. The committee did not reach a consensus on the role of FAF and OCTA for the diagnosis or monitoring of BSCR. Conclusions: The MUV consensus-based imaging guidelines for BSCR expand the Standardization of Uveitis Nomenclature (SUN) classification criteria by reaffirming the critical role of ICGA and providing a standardized guidelines for using other imaging modalities in the diagnosis and monitoring of BSCR. These guidelines are expected to facilitate monitoring of disease activity and complications using multimodal imaging
‘Questioning’ the Truth Effect: Processing information in interrogative form reduces (but does not cancel) repetition-induced truth
No full textPeople attribute higher truth to information they have previously been exposed to. This “truth effect” is resistant to many interventions aimed to reduce it. In three preregistered experiments, we explored whether processing largely unknown information in the form of questions could counteract repetition-induced truth. In Experiment 1 (N = 100), participants judged the truth of repeated and unrepeated sentences. Half of the participants processed sentences in declarative form and the other half processed them in interrogative form during exposure and judgment. A significant interaction between sentence repetition and sentence form emerged, with a significant truth effect in the declarative condition but not in the interrogative. Experiment 2 (N = 325) introduced an additional interrogative condition presenting sentences as questions only during the exposure phase. Compared with the declarative condition, the truth effect was greatly reduced, but still significant, in both interrogative conditions. Experiment 3 (N = 235) employed a within-participant design to manipulate both repetition and sentence form. We confirmed that the truth effect was substantially reduced for interrogative sentences. Additionally, repetition had a smaller effect on certainty about truth judgments for interrogative compared with declarative sentences. We discuss how these findings inform theoretical accounts of the truth effect and their implications for debiasing strategies
Management of recurrent varicose veins: Redo open surgery versus endovascular approaches
No full textObjective: Recurrent varicose veins (RVVs) following open surgical procedures are common and present significant treatment challenges. Redo open surgery (rOS) presents risks leading to a need for alternative treatment options. This study compares the safety and efficacy of ultrasound-guided foam sclerotherapy (UGFS), used to treat recurrent reflux and remove neovascular and tributary venous networks in the thigh, to redo open surgery (rOS) for the treatment of C2r. Materials and methods: A retrospective review was conducted on 133 patients with symptomatic C2r treated between 2018 and 2020. Of these, 91 patients received UGFS-based mini-invasive treatment (Group A), and 42 underwent rOS (Group B). Data were collected during perioperative, intraoperative, and postoperative times. Clinical outcomes were assessed using the CEAP and rVCSS scoring systems. Follow-up occurred within 1 week, at 1-6 months, and annually thereafter. Results: UGFS showed a significantly shorter average procedure time (21 ± 7 minutes) compared to rOS (47 ± 13 minutes, p < .001) and time spent in the hospital (3 ± 0.5 hours vs 16 ± 2 hours, p < .001). Both groups achieved high technical success rates. The anterior saphenous vein (ASV) was found to be incompetent in 32 patients (24%). In Group A, it was treated with radiofrequency ablation (RFA) in 10 cases and with foam sclerotherapy in 11. In contrast, all ASV cases in Group B were managed with surgical stripping. UGFS patients experienced a more rapid clinical improvement within the first-week post-treatment (p < .001). The freedom from recurrences was 88.9% in the Group A, and 87.8% in the Group B at 3-year (p = .85). The freedom from reintervention was 90.9% in the Group A, and 88.5% in the Group B at 3-year (p = .89). Conclusions: UGFS is a safe and effective alternative to rOS for treating C2r, offering significant advantages in shorter procedure times, faster recovery, and similar medium-term outcomes. This approach provides a viable option for C2r patients seeking effective treatment with reduced recovery periods
Comparative analysis of Denosumab and Zoledronic acid in advanced breast cancer patients receiving CDK4/6 inhibitors
No full textA comparative analysis of Denosumab (DMAB) and Zoledronic Acid (ZA) was conducted in a real-world cohort of 864 patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer with bone metastases, who were undergoing CDK4/6 inhibitors plus endocrine therapy. We evaluated the time to first skeletal-related events (SREs), progression-free survival (PFS), and overall survival (OS). To adjust for confounding variables, we utilized propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) methodologies. In the unadjusted cohort, ZA was associated with a longer time to first SRE compared to DMAB (HR = 0.77, 95 % CI: 0.61–0.98, p = 0.031). Similar results were obtained in both the PSM (HR = 0.69, 95 % CI: 0.52–0.92, p = 0.011) and IPTW cohorts (HR = 0.74, 95 % CI: 0.63–0.87, p < 0.001), with ZA-treated patients showing an extended time to first SRE compared to those treated with DMAB. No differences in PFS and OS were observed between the two cohorts
Short-term outcomes of minimally invasive gastrectomy in population with obesity versus population without obesity: the obesity paradox
No full textThis study aims to compare the short-term outcomes after minimally invasive gastrectomy between obese and non-obese population. Our analysis included data of 713 patients from ten departments of surgery. They were divided in non-obese group and obese group with 617 and 96 patients respectively. Significant differences were found in terms of mortality at 90 days (obese: 0 vs non-obese: 27, p = 0.037). Intraoperative data showed no significant differences in terms of conversion (obese: 4 vs non-obese: 43, p = 0.303). About postoperative complications, significant differences between the two groups were found only in terms of surgical infection (obese: 13 vs non-obese: 38, p = 0.009). About oncological outcomes, no differences were found about retrieved lymph nodes (obese: 30.71 ± 18.44 vs non-obese: 32.93 ± 17.62, p = 0.596) and about surgical radicality (R0) (obese:94 vs non-obese:594, p = 0.415). Obesity doesn’t worsen postoperative outcomes and minimally invasive gastrectomy in obese patients is related to a lower postoperative mortality
Soft tissue augmentation procedures for natural teeth and dental implants: an overview of systematic reviews
No full text: This is a protocol for a Cochrane Review (overview). The objectives are as follows: To synthesise the evidence from Cochrane and non-Cochrane systematic reviews of randomised controlled trials on the comparative clinical effectiveness, aesthetic, and patient-reported outcomes of soft tissue augmentation procedures with or without the use of soft tissue substitutes around teeth, dental implants, or both
Indocyanine green fluorescence video-angiography for flap perfusion assessment in head and neck reconstruction: a prospective study
No full textPurpose: Managing postoperative complications is crucial in reconstructive surgery. Indocyanine green fluorescence video-angiography (ICGA) aids in assessing flap vascularization intraoperatively, potentially reducing complications. Methods: An ambispective study enrolled head and neck cancer patients undergoing ablative surgery with soft tissue reconstruction. An experimental arm (March 2021-May 2023) used ICGA, while a control arm (January 2017-December 2020) did not. Complications were graded by Clavien-Dindo classification. We also evaluated the effect of systemic inflammation on the sensitivity of ICGA in detecting hypoperfused areas of the flap. Results: Complications were less frequent in the experimental arm, both overall (11.4% vs. 36.4%) and major ones (Clavien-Dindo ≥ 3) (8.6% vs. 30.9%). ICGA showed a protective effect in univariate and multivariate analyses. Previous radiation and ICGA were independent predictors of major complications. ICGA altered the surgical strategy in 25.7% of cases. Conclusions: Real-time perfusion assessment, particularly with ICGA, can improve outcomes in head and neck cancer patients undergoing soft tissue reconstruction by reducing complications. Further research with larger cohorts is warranted for validation.Purpose: Managing postoperative complications is crucial in reconstructive surgery. Indocyanine green fluorescence video-angiography (ICGA) aids in assessing flap vascularization intraoperatively, potentially reducing complications. Methods: An ambispective study enrolled head and neck cancer patients undergoing ablative surgery with soft tissue reconstruction. An experimental arm (March 2021-May 2023) used ICGA, while a control arm (January 2017-December 2020) did not. Complications were graded by Clavien-Dindo classification. We also evaluated the effect of systemic inflammation on the sensitivity of ICGA in detecting hypoperfused areas of the flap. Results: Complications were less frequent in the experimental arm, both overall (11.4% vs. 36.4%) and major ones (Clavien-Dindo ≥ 3) (8.6% vs. 30.9%). ICGA showed a protective effect in univariate and multivariate analyses. Previous radiation and ICGA were independent predictors of major complications. ICGA altered the surgical strategy in 25.7% of cases. Conclusions: Real-time perfusion assessment, particularly with ICGA, can improve outcomes in head and neck cancer patients undergoing soft tissue reconstruction by reducing complications. Further research with larger cohorts is warranted for validation
Association between red and processed meat consumption and colorectal cancer risk: a comprehensive meta-analysis of prospective studies
Get PDFIncreasing evidence suggests that red and processed meat consumption may elevate the risk of colorectal cancer (CRC), yet the magnitude and consistency of this association remain debated. This meta-analysis aims to quantify the relationship between red and processed meat intake and the risk of CRC, colon cancer, and rectal cancer using the most comprehensive set of prospective studies to date. We conducted a comprehensive search in PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases from 1990 to November 2024, to identify relevant prospective studies examining red, processed, and total meat consumption in relation to colorectal, colon, and rectal cancer risk. Hazard ratios (HR) and 95% confidence intervals (CI) were extracted for each study and pooled using a random-effects model to account for variability among studies. Statistical evaluation was executed using the online platform MetaAnalysisOnline.com. A total of 60 prospective studies were included. Red meat consumption was associated with a significantly increased risk of colon cancer (HR = 1.22, 95% CI 1.15–1.30), colorectal cancer (HR = 1.15, 95% CI 1.10–1.21), and rectal cancer (HR = 1.22, 95% CI 1.07–1.39). Processed meat consumption showed similar associations with increased risk for colon cancer (HR = 1.13, 95% CI 1.07–1.20), colorectal cancer (HR = 1.21, 95% CI 1.14–1.28), and rectal cancer (HR = 1.17, 95% CI 1.05–1.30). Total meat consumption also correlated with an elevated risk of colon cancer (HR = 1.22, 95% CI 1.11–1.35), colorectal cancer (HR = 1.17, 95% CI 1.12–1.22), and rectal cancer (HR = 1.28, 95% CI 1.10–1.48). This meta-analysis provides robust evidence that high consumption of red and processed meats is significantly associated with an increased risk of colorectal, colon, and rectal cancers. These findings reinforce current dietary recommendations advocating for the limitation of red and processed meat intake as part of cancer prevention strategies
Clinical and neuroradiological red flags in differential diagnosis of pituitary metastases and PitNETs (adenomas): a surgeon's experience and systematic literature review
Get PDFIntroduction: Pituitary metastases (PMs) are rare malignancy manifestations, generally deemed to have an extremely poor prognosis. Differential diagnosis from primary pituitary lesions is often difficult, as their features can mimic those of pituitary neuroendocrine tumours (PitNETs). This study aimed to report a single surgeon's experience in managing PMs and to gather the existing evidence on their clinical and neuroradiological presentation to build a model of 'red flags' that help raise the suspicion of PMs in the context of sellar lesions. Material and methods: We retrieved an original 10-year surgical series of patients undergoing endoscopic transsphenoidal (TNS) surgery for suspected PitNETs, and we additionally conducted a systematic review of case reports or series of patients with PMs. Results: The local series consisted of n = 6 PMs. The literature review yielded n = 149 works reporting n = 340 PMs. Overall, the clinical presentation and neuroradiological features of n = 346 PMs were analysed and compared to data retrieved from n = 361 PitNETs from our original cohort. Primary features associated with PMs were: the presence of headaches (OR 1.24, p = 0.001), visual field deficits (OR 1.19, p = 0.02), extraocular nerve palsies (OR 1.23, p = 0.001), diabetes insipidus (OR 2.13, p < 0.001), MRI features of pituitary stalk/infundibular involvement (OR 1.98, p = 0.001), cavernous sinus invasion (OR 1.57, p = 0.004), and T2w flow voids (OR 1.13, p = 0.001). An incidental diagnosis (OR 0.49, p < 0.001) and cystic changes (OR 0.77, p = 0.02) were less common among PMs. Secondary features involved an acute onset of symptoms (OR 1.25, p = 0.001), the presence of oncological history (OR 1.89, p = 0.001), sellar walls erosion (OR 1.55, p = 0.002), and gross appearance of a firm (OR 2.01, p < 0.001) and easily bleeding lesion (OR 1.99, p < 0.001). Sellar enlargement predicted a lower risk of PMs (OR 0.54, p = 0.001). Conclusion: We have compiled a list of primary and secondary red flags, including clinical and neuroradiological features, to serve as a guiding tool for clinicians to raise suspicion of PMs and aid in the differential diagnosis of various lesions centered in the sella
Corrigendum to Evidence and Consensus-Based Imaging Guidelines in Multifocal Choroiditis With Panuveitis and Punctate Inner Choroiditis-Multimodal Imaging in Uveitis (MUV) Taskforce Report 5. Am J Ophthalmol. 2025;276:272-285 (American Journal of Ophthalmology (2025) 276 (272–285), (S0002939425001953), (10.1016/j.ajo.2025.04.018))
No full textThe authors regret affiliation #13 has an error. The correct affiliation is IRCCS Fondazione Bietti, Rome, Italy. The authors would like to apologise for any inconvenience caused