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Summary of the 2024 Update of the European Association of Urology Guidelines on Neurourology.
No full textBACKGROUND AND OBJECTIVE
Most patients with neurourological disorders require lifelong medical care. The European Association of Urology (EAU) regularly updates guidelines for diagnosis and treatment of these patients. The objective of this review is to provide a summary of the 2024 updated EAU guidelines on neurourology.
METHODS
A structured literature review covering the timeframe 2021-2023 was conducted for the guideline update. A level of evidence and a strength rating were assigned for each recommendation on the basis of the literature data.
KEY FINDINGS AND LIMITATIONS
Neurological conditions significantly affect urinary, sexual, and bowel function, and lifelong management is required for neurourological patients to maintain their quality of life and prevent urinary tract deterioration. Early diagnosis and effective treatment are key, and comprehensive clinical assessments, including urodynamics, are crucial. Management should be customised to individual needs and should involve a multidisciplinary approach and address sexuality and fertility. Lifelong monitoring and follow-up highlight the importance of continuous care for neurourological patients.
CONCLUSIONS AND CLINICAL IMPLICATIONS
The 2024 EAU guidelines on neurourology provide an up-to-date overview of available evidence on diagnosis, treatment, and follow-up for neurourological patients.
PATIENT SUMMARY
Neurological disorders very frequently affect the lower urinary tract and sexual and bowel function and patients need lifelong management. We summarise the updated European Association of Urology guidelines on neurourology to provide patients and caregivers with the latest insights for optimal health care support
Learning with an evolving medicine label: how artificial intelligence-based medication recommendation systems must adapt to changing medication labels.
No full textArtificial intelligence or machine learning (AI/ML) based systems can be used to help personalize prescribing decisions for individual patients. These AI/ML clinical decision support systems may provide either specific or more open-ended recommendations for the most appropriate medications to prescribe. These systems must fundamentally relate to the label of the medicines involved. The label of a medicine is an approved guide that indicates how to prescribe the drug in a safe and effective manner. The label for a medicine may evolve as new information on safety and effectiveness emerges, leading to the addition or removal of warnings, drug-drug interactions, or to permit new indications. Therefore, any AI/ML recommendation system would need to reference these label updates. However, the speed and consistency which these updates are made may influence the safety of prescribing decisions, since change control procedures and revalidation of algorithms may slow down any changes. This is especially important if changes need to be made quickly to protect patients. These considerations highlight the important role that pharmacoepidemiologists and drug safety professionals must play within this conversation. Furthermore, the guiding role that regulators have in regulating the development and use of these AI/ML clinical decision support systems is highlighted
Prediction of Mortality and Heart Failure Hospitalization After Transcatheter Tricuspid Valve Interventions: Validation of TRISCORE.
No full textBACKGROUND
Data on the prognostic role of the TRI-SCORE in patients undergoing transcatheter tricuspid valve intervention (TTVI) are limited.
OBJECTIVES
The aim of this study was to evaluate the performance of the TRI-SCORE in predicting outcomes of patients undergoing TTVI.
METHODS
TriValve (Transcatheter Tricuspid Valve Therapies) is a large multicenter multinational registry including patients undergoing TTVI. The TRI-SCORE is a risk model recently proposed to predict in-hospital mortality after tricuspid valve surgery. The TriValve population was stratified based on the TRI-SCORE tertiles. The outcomes of interest were all-cause death and all-cause death or heart failure hospitalization. Procedural complications and changes in NYHA functional class were also reported.
RESULTS
Among the 634 patients included, 223 patients (35.2%) had a TRI-SCORE between 0 and 5, 221 (34.8%) had 6 or 7, and 190 (30%) had ≥8 points. Postprocedural blood transfusion, acute kidney injury, new atrial fibrillation, and in-hospital mortality were more frequent in the highest TRI-SCORE tertile. Postprocedure length of stay increased with a TRI-SCORE increase. A TRI-SCORE ≥8 was associated with an increased risk of 30-day all-cause mortality and all-cause mortality and the composite endpoint assessed at a median follow-up of 186 days (OR: 3.00; 95% CI: 1.38-6.55; HR: 2.17; 95% CI: 1.78-4.13; HR: 2.08, 95% CI: 1.57-2.74, respectively) even after adjustment for procedural success and EuroSCORE II or Society of Thoracic Surgeons Predicted Risk of Mortality. The NYHA functional class improved across all TRI-SCORE values.
CONCLUSIONS
In the TriValve registry, the TRI-SCORE has a suboptimal performance in predicting clinical outcomes. However, a TRISCORE ≥8 is associated with an increased risk of clinical events and a lack of prognostic benefit after successful TTVI
The Inheritance of Looting: A Virtual Exhibition
No full textConference Präsentation beim Zweites Arbeitstreffen der militärhistorischen Museen und Sammlungen Bayerisches Armeemuseum, Ingolstadt, Dienstag, den 9. April 202
Feline Facial Spindle Cell Tumors in 29 Cats: Histomorphological and Immunohistochemical Characterization.
Get PDFSoft tissue tumors/sarcomas (STSs) in felines, encompassing a variety of mesenchymal tumors with similar histomorphological features, present diagnostic challenges due to their diverse cellular origins and the overlap with other tumor types such as feline sarcoid. This study aimed to delineate the clinical, histomorphological, and immunohistochemical characteristics of 34 feline facial spindle cell tumors affecting 29 cats, including testing for bovine papillomavirus type 14 (BPV14), the virus causing feline sarcoids. Only five out of 12 tumors previously diagnosed as feline sarcoids based on histomorphology were confirmed by PCR for BPV14, underscoring the importance of comprehensive diagnostic approaches to accurately distinguish between STSs and feline sarcoids. This study shows that most facial spindle cell tumors were compatible with peripheral nerve sheath tumors (PNSTs) based on positive immunohistochemical staining for Sox10 and other immunohistochemical markers such as GFAP, NSE, and S100. Some of these tumors displayed as multiple independent masses on the face or as erosive and ulcerative lesions without obvious mass formation, an atypical presentation and an important highlight for general practitioners, dermatologists, and oncologists. This study also describes periadnexal whorling of neoplastic cells as a novel histomorphologic finding in feline facial PNSTs and emphasizes Sox10 as a useful complementary immunohistochemical marker for the diagnosis of facial PNST in cats, providing valuable insights for veterinary pathologists
Treatment response biomarkers: working towards personalised radiotherapy for lung cancer.
Get PDFDue to major advances in the field of radiation oncology, patients with lung cancer (LC) can now receive technically individualised radiotherapy treatments. However, in the era of precision oncology, radiotherapy-based treatment selection needs to be improved as many patients do not benefit or are not offered optimum therapies. Cost-effective robust biomarkers can address this knowledge gap and lead to individuals being offered more bespoke treatments leading to improved outcome. This narrative review discusses some of the current achievements and challenges in the realisation of personalised radiotherapy delivery in patients with LC
The Necessity of System Change: An Ecological and Marxian Synthesis
No full textIn a world of convergent crises, leading voices have called for radical changes to food, financial, and energy systems. However, these fail to account for a deeper systemic crisis: unfettered and accelerating of capital accumulation. In this article, M. Graziano Ceddia and Jacopo Nicola Bergamo provide a more comprehensive narrative, one which emphasizes capital as a social relation—and the potential of the environmental proletariat to dismantle its dominance
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