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Hypersensitivity to RhD immune globulin (RhIG) used to prevent hemolytic disease of the fetus and newborn is rare. We present the management of a patient with a history of reaction to RhIG, including prenatal assessment and postnatal provision of RhIG.
[This corrects the article DOI: 10.3389/fped.2026.1811714.].
BACKGROUNDAcute interstitial nephritis (AIN) is a common cause of acute kidney injury (AKI), but the diagnosis may be missed as kidney biopsies are rarely obtained when acute tubular injury (ATI) is suspected.METHODSThe Kidney Precision Medicine Project is a cohort study that obtains kidney biopsies from individuals with AKI, which undergo pathologic and molecular interrogation. We compared ATI and AIN cases among the first 60 AKI participants.RESULTSOn clinicopathologic adjudication, 30 patients (50%) had a primary adjudicated diagnosis of ATI, 13 (22%) patients had AIN, 9 (15%) had diabetic nephropathy, and 3 (5%) had other conditions. There were increased interstitial white blood cells and tubulitis (P < 0.05 for both) in AIN compared with ATI. Prior to biopsy, the treating clinician suspected ATI in 83% of the cases with adjudicated ATI, while the treating clinician suspected AIN in 54% of the cases with AIN. Tissue transcriptomic signatures showed enrichment of proinflammatory signaling and increased expression of CXCL9, a chemokine induced by IFN-γ, in myeloid cells of participants with AIN. CXCL9 localized to inflammatory infiltration in spatial transcriptomic data.CONCLUSIONAdjudication of kidney biopsies revealed distinct pathologic and molecular profiles between ATI and AIN. Kidney biopsy should be considered more frequently in AKI, as AIN is clinically underrecognized.TRIAL REGISTRATIONClinicalTrials.gov NCT04334707.FUNDINGNational Institute of Diabetes and Digestive and Kidney Diseases grants U01DK133081, U01DK133091, U01DK133092, U01DK133093, U01DK133095, U01DK133097, U01DK114866, U01DK114908, U01DK133090, U01DK133113, U01DK133766, U01DK133768, U01DK114907, U01DK114920, U01DK114923, U01DK114933, U24DK114886, UH3DK114926, UH3DK114861, UH3DK114915, and UH3DK114937.
Renal disease in cattle is often suspected based on urinalysis and blood biochemical analysis, but prognostic biomarkers for survival are lacking. Identify blood and urine biomarkers predicting mortality or discharge in azotemic cattle. Thirty-four azotemic adult cattle referred to the Clinic for Cattle of the National Veterinary School of Toulouse. In our prospective cohort study, renal disease was suspected based on clinical signs and azotemia (plasma creatinine concentration > 228 μmol/L and urea concentration > 5 mmol/L) and confirmed by urinalysis or ultrasonography. When death or euthanasia occurred, confirmation was obtained by gross and histologic examination. To construct a decision tree for short-term prognosis, additional biochemical and cytological biomarkers were measured in urine and blood samples collected at hospitalization. Outcomes were defined as favorable (discharge) or unfavorable (death). Correlation analyses, univariate and multivariate statistics, receiver operating characteristic curves, and decision tree modeling were performed. Thirteen cattle survived and 21 died or were euthanized. Mortality was associated with higher plasma symmetric dimethylarginine (SDMA), creatinine, and urea concentrations, as well as hypocalcemia, hypochloremia, and lower hematocrit. Creatinine, SDMA, chloride, and albumin were the most consistent predictors of outcome. A decision tree combining creatinine and SDMA achieved 87.5% accuracy. Animals with plasma creatinine concentration < 605 μmol/L and SDMA < 33 μg/dL had the highest probability of survival. Plasma creatinine, urea, SDMA, chloride, and albumin concentrations are promising short-term prognostic biomarkers in azotemic cattle. Combined SDMA and creatinine assessment may assist clinical decision-making.
Antibody testing has a pivotal role in the diagnosis of myasthenia gravis (MG). However, there are limited data on the accuracy of the different methods available for acetylcholine receptor (AChR) and muscle-specific kinase (MuSK) autoantibody (Ab) detection in a real-world setting. Our aim was to compare the diagnostic accuracy of in-house live cell-based assay (L-CBA), a commercially available fixed CBA (F-CBA), and an indirect ELISA in detecting AChR and MuSK antibodies in patients with suspected MG. Between July 2023 and December 2025, we prospectively recruited consecutive adult and pediatric patients with suspected MG across 4 Italian centers. Patients undergoing immunotherapy and those with incomplete diagnostic work-up or insufficient samples were excluded. Serum samples were tested blindly by L-CBA, F-CBA, and ELISA for AChR and MuSK antibodies. MG diagnosis was established independently based on neurologic examination, electrophysiologic studies, and/or sustained clinical response to pyridostigmine or corticosteroids as well as exclusion of other diagnoses. Diagnostic sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated using final diagnosis as the reference standard. Of the 327 included patients (median age 63 years, interquartile range 26, 52.9% female), 152 were diagnosed with MG and 175 with other diagnoses. For AChR antibodies, sensitivity was 71.7% (95% CI 63.8-78.7) for L-CBA, 69% (61.0-76.3) for F-CBA, and 63.8% (55.6-71.4) for ELISA, while specificity was 97.7% (94.2-99.3) for both CBAs vs 69.1% (61.7-75.9) for ELISA. ELISA showed lower concordance with CBAs and produced substantially more false positives (30.9%). For MuSK antibodies, sensitivity was similar (6.6 vs 7.2%) and specificity 100% across assays. ROC curve analysis confirmed higher diagnostic accuracy for L-CBA (AUC 0.85) compared with F-CBA (0.83) (p = 0.043) and ELISA (0.72) (p < 0.0001). The AUCs of MuSK-Ab were not significantly different between different tests. CBAs, especially live, demonstrated superior diagnostic performance for AChR antibody detection compared with ELISA, particularly in ocular MG. L-CBA showed a modest but significant diagnostic advantage over F-CBA, although fixed assays can be considered as a practical, nearly equivalent alternative, suitable for routine laboratories. By contrast, ELISA demonstrated lower specificity and should be interpreted cautiously. This study shows Class I data that L-CBA and F-CBA compare favorably with ELISA testing of AChR-Ab and MuSK-Ab, in the diagnosis of MG.
Cytomegalovirus (CMV) infections often occur as opportunistic infections among immunocompromised hosts. We report a case of CMV colitis that resulted in colonic perforation in a patient undergoing chemotherapy for more than 2 years for metastatic colorectal cancer (mCRC). A 61-year-old man receiving long-term chemotherapy for mCRC presented with persistent diarrhea and anorexia. Colonoscopy revealed ulcerating colorectal lesions. Following admission, he exhibited signs of peritoneal irritation and bloody stools. Computed tomography demonstrated intraperitoneal free air, prompting an emergency operation. Considering the perforations in the descending colon, we performed Hartmann's operation. However, in addition to the histopathological results, bloody stools persisted postoperatively; thus, enteritis caused by CMV infection was suspected. Furthermore, CMV pp65 antigen-positive blood cells were detected, leading to the diagnosis of CMV colitis. Consequently, ganciclovir was administered, and persistent bloody stools resolved. CMV infection occurs asymptomatically during childhood and then remains latent in the body over time. Although CMV colitis is common in patients undergoing chemotherapy for hematologic malignancies, it is rare in mCRC cases. However, immunocompromised patients receiving long-term steroid therapy for chemotherapy are at a high risk of CMV reactivation. Therefore, CMV colitis should be considered one of the differential diagnoses based on persistent diarrhea and bloody stools, as well as ulcer formation observed on colonoscopy. Although CMV enteritis during colorectal cancer chemotherapy is rare, CMV colitis should be suspected if patients experience prolonged diarrhea or bloody stools during chemotherapy. Therefore, early diagnosis by detecting CMV antigen-positive blood cells is important.
Multidisciplinary genomic evaluation is increasingly recognized for its diagnostic and therapeutic implications in adults with suspected inborn errors of immunity (IEI) presenting with rheumatic and musculoskeletal disease (RMD) phenotypes. We retrospectively analyzed 50 adults with suspected IEI who underwent genetic testing and were pre-classified into immunodeficiency (ID), autoinflammatory disorders (AID), and non-ID/AID groups. Genetic findings, clinical classification, treatment modifications, and exploratory machine learning analyses were evaluated. A final genetic diagnosis consistent with IEI was identified in 15 patients (30.0%), with the highest yield in the non-ID/AID group (44.4%). Variants were most frequently associated with autoinflammatory diseases (40.0%). Four patients, all initially classified as non-ID/AID, were reclassified based on genetic findings and IUIS classification. Treatment was modified in 12 patients, including eight genetically diagnosed patients and three genotype-driven interventions. Two patients died from disease-related complications. Machine learning analyses provided heterogeneous feature contributions across groups. These findings highlight the utility of multidisciplinary genomic evaluation for refining diagnoses in challenging adult patients.
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, yet acute lower gastrointestinal bleeding as a presentation in adults remains uncommon and diagnostically challenging. This case highlights the importance of early surgical decision-making in this setting. A 20-year-old male with no medical history presented with 2 days of hematochezia. Hemoglobin levels declined over 72 hours. The patient developed hemodynamic instability and episodes of syncope, which were managed on the surgical ward without vasopressor support. Upper and lower endoscopies were unremarkable. Contrast-enhanced computed tomography (CT) identified a blind-ending ileal structure consistent with MD. Laparoscopic exploration confirmed a 7 × 2 cm MD located 140 cm from the ileocecal valve. A 10-cm ileal segment was resected, and a hand-sewn anastomosis was performed. Histopathology confirmed ectopic gastric fundic-type mucosa without ulceration. The postoperative course was complicated by a transient paralytic ileus (Clavien-Dindo grade II), which was managed conservatively, with discharge on day 6. MD should be considered in young adults with unexplained hematochezia when standard endoscopy is negative. CT imaging is key in identifying MD. Segmental bowel resection is preferred when ectopic mucosa is suspected. While technetium-99 m pertechnetate scanning may be considered in stable patients with suspected MD, its sensitivity in adults is lower than in children. Surgical resection remains the definitive treatment for symptomatic cases. Prophylactic excision of incidentally discovered MD may be considered in selected patients with risk factors for complications, though this decision should be individualized and weighed against surgical risks.
Hymenal examination plays an important role in the forensic examination of suspected child sexual abuse. However, interpretation of hymenal findings remains challenging because of anatomical variation and subtle genital injuries, creating the potential for misinterpretation in medico-legal assessments. This study aimed to characterize hymenal morphology, hymenal injuries, and related forensic findings among female child sexual abuse victims in Vietnam and to examine patterns associated with repeated abuse. A retrospective analysis was conducted using forensic examination records of female children under 16 years of age referred for suspected sexual abuse at a specialized medico-legal center. Sociodemographic characteristics, assault-related information, hymenal morphology, and genital and extra-genital injuries were extracted from standardized forensic reports. Cases with diagnostic uncertainty or complex forensic findings were reviewed through expert consultation, and final conclusions were established by consensus within the forensic assessment team. A total of 443 children were included, with a mean age of 13.3 ± 2.6 years. The median interval between the alleged assault and forensic examination was 19 days (IQR: 4-89 days). Repeated sexual abuse accounted for 68.4% of cases. In multivariable analysis, older age (aOR = 1.25, 95% CI: 1.14-1.37), parental divorce (aOR = 1.95, 95% CI: 1.15-3.30), and abuse occurring in private or semi-private settings were independently associated with repeated sexual abuse. The annular hymen was the most frequently observed morphology (60.3%). Overall, 69.3% of cases showed combined hymenal dilatation and tear, followed by tear only (19.6%) and dilatation only (6.3%), while 4.7% had no hymenal injury. Most tears were old (81.7%) and located in the anterior region (65.2%). Additional genital and extra-genital injuries were uncommon. Repeated sexual abuse was common among examined victims. The annular hymen was the most frequently observed morphology, and combined hymenal dilatation and tear was the predominant injury pattern, while other genital and extra-genital injuries were uncommon. While these findings provide additional forensic reference data, no single hymenal morphology or injury pattern should be interpreted as diagnostic of sexual abuse in isolation and findings should be considered within the broader clinical and investigative context.
Diffuse lung diseases (DLD) also referred to as diffuse parenchymal lung diseases or interstitial lung diseases encompass diverse disorders affecting the lung parenchyma with possible multicompartment involvement in the chest. DLD include several hundred established clinical syndromes and pathologies, with a variety of possible etiologies. Imaging plays a central role during multidisciplinary discussion, which constitutes the current standard for diagnosis and monitoring of DLD. This document aims to establish guidelines for evaluation of diffuse lung diseases for 1) initial imaging of suspected diffuse lung disease, 2) initial imaging of suspected acute exacerbation or acute deterioration in cases of confirmed diffuse lung disease, and 3) surveillance of confirmed diffuse lung disease without acute deterioration. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Patients with sitosterolemia (ST) are often misdiagnosed as familial hypercholesterolemia (FH) because of overlapping lipid phenotypes. Sitosterol is considered a disease-specific biomarker; however, its diagnostic utility in highly heterogeneous populations-particularly among children-remains unclear. To evaluate the diagnostic value of phytosterol biomarkers and develop a multivariate model to improve the diagnostic accuracy of ST. We conducted a cross-sectional study of 379 children with suspected lipid disorders: ST (n = 38), ABCG5/8 heterozygous carriers (n = 12), genetically confirmed FH (n = 54), individuals with FH-like (n = 50), and healthy controls (n = 225). Clinical characteristics, lipid profiles, phytosterols, liver enzymes, and genetic data were collected. The diagnostic performance of single biomarkers and a multivariate model was evaluated. A clinical gray zone based on sitosterol levels was defined to assess the models' ability. Sitosterol demonstrated near-perfect discrimination for ST in the overall population area under the curve ([AUC] 0.994; 95% CI, 0.988-1.000), outperforming conventional lipid markers. However, substantial overlap in phytosterol distributions was observed among ST, heterozygotes, and FH-related phenotypes. Within the gray zone (sitosterol: 17.7-50 μg/mL), the diagnostic performance of sitosterol declined markedly (AUC 0.653). The multivariable model demonstrated comparable overall performance (AUC 0.983) but significantly improved discrimination in the gray zone (AUC 0.806), with good calibration and greater net clinical benefit. Although sitosterol is highly effective for identifying ST, its diagnostic performance declines significantly in clinically significant gray zone cases. A combined sterol-based model improves diagnostic discrimination in these challenging scenarios and supports a stepwise diagnostic strategy for children with suspected ST.
Constitutional indocyanine green (ICG) excretory defect is a rare condition characterized by markedly impaired ICG clearance despite preserved conventional liver function. This discrepancy makes the preoperative assessment of hepatic functional reserve difficult. We report two patients with hepatocellular carcinoma (HCC) and constitutional ICG excretory defect who underwent hepatectomy based on multimodal functional assessment. Case 1 was a 71-year-old man with a 40-mm HCC involving segments 5 and 8. The indocyanine green retention rate at 15 minutes (ICGR15) was 94.3%, whereas other liver function tests were preserved. Galactosyl human serum albumin (GSA) scintigraphy and fibrosis-related markers supported adequate hepatic reserve, and right anterior sectionectomy was safely performed. Case 2 was an 80-year-old man with a 30-mm recurrent HCC in segment 4, contacting the middle hepatic vein. Although ICGR15 was markedly elevated at 80.0%, conventional liver function tests and GSA scintigraphy suggested acceptable hepatic reserve. Extended left hepatectomy was performed without postoperative liver failure. These cases illustrate that markedly elevated ICGR15 does not necessarily indicate impaired hepatic functional reserve in patients with a constitutional ICG excretory defect. When ICGR15 is disproportionately elevated relative to conventional liver function, alternative assessment methods are required. GSA scintigraphy may help guide surgical decision-making in this rare condition. A constitutional ICG excretory defect should be suspected when ICGR15 is markedly elevated despite preserved liver function. In selected patients, hepatectomy may be feasible when the surgical indication is determined using multimodal functional assessment, particularly GSA scintigraphy.
Children's increasing use of digital platforms elevates their risk for online sexual exploitation (OSE), especially among those with sexual abuse histories. Despite known risk, data on prevalence and related characteristics remain limited. Digital safety screening (DSS) offers child abuse professionals a tool to assess risk or prior exploitation but is not standardized. To examine age-related variation in OSE disclosure within a clinically relevant population and characterize how DSS is applied in this clinical setting. A retrospective chart review was conducted of 307 patients aged 10-18 years who received forensic interviews (FIs) for evaluation for suspected sexual abuse by a single social worker between 2022 and 2024 at a Child Advocacy Center in the Midwestern United States. FI notes were analyzed through content analysis to characterize the utilization of DSS and patient disclosure or denial of OSE. Descriptive statistics revealed prevalence: logistic regression examined associations between patient age and OSE. Of 307 patients, 96.1% received DSS. Among 299 who discussed OSE, 41.5% reported at least one experience. Odds of reporting increased with age, beginning at 12.0% at age 10, 27.3% at 11, and increasing to 60.0% at age 16. OSE exposure likely increases with age and may vary by sex assigned at birth. Findings underscore the need for routine, standardized DSS validated across developmental stages and languages, as well as further research on prevalence and risk and prevention and response strategies.
Necrotizing laryngotracheobronchitis (NLTB) is a rare and life-threatening airway disease characterized by mucosal necrosis, ulceration and pseudomembrane formation. Mycoplasma pneumoniae-associated NLTB remains exceedingly rare in children, with merely sporadic cases reported globally. Four previously healthy children hospitalized with M. pneumoniae-associated NLTB from January 2023 to June 2025 were enrolled retrospectively. We systematically analyzed clinical features, etiological findings, therapeutic regimens and follow-up outcomes of these cases, and reviewed relevant literature. The main clinical manifestations included fever, cough, hoarseness, tachypnea and dyspnea. Bronchoscopy confirmed the diagnosis of NLTB. Notably, most patients presented with disproportionately severe airway symptoms compared with radiological lesions. Combined etiological tests and targeted next-generation sequencing (tNGS) confirmed mixed infections in three cases. All children received macrolides or doxycycline plus glucocorticoids, and most underwent repeated bronchoscopic procedures. All achieved clinical remission and were discharged uneventfully. During follow-up, one patient developed tracheal granulation tissue hyperplasia, and the other developed bronchitis obliterans. M. pneumoniae-associated NLTB should be strongly suspected in pediatric patients with M. pneumoniae infection who present with hoarseness, tachypnea, or dyspnea that cannot be fully explained by chest imaging findings. Bronchoscopy combined with pathogenic detection and tNGS constitutes the cornerstone of diagnosis. Standardized multimodal therapy, including antimicrobials, anti-inflammatory agents, and endoscopic intervention, improves short-term clinical outcomes. Long-term follow-up is indispensable for identifying and managing delayed airway sequelae.
An early adolescent boy, born to a consanguineously married couple, with mild baseline developmental delay, presented with fever-triggered acute encephalopathy manifesting as ataxia, tremors and seizures. Neuroimaging revealed multifocal, symmetric involvement of the insular cortex, basal ganglia, temporo-occipital regions and cerebellum with diffusion restriction. Extensive infectious, autoimmune and metabolic evaluation during the first episode was inconclusive, and he was treated as immune-mediated encephalitis with partial recovery. Three months later, febrile illness precipitated a severe relapse with neurological regression, movement disorder and progressive cerebellar atrophy on follow-up imaging. Given the relapsing fever-triggered course, baseline developmental delay, incomplete recovery, negative autoimmune workup and progressive neuroimaging changes without new inflammatory lesions, a genetic aetiology was suspected. Genetic testing identified a homozygous variant in the NUP214 gene, supporting a diagnosis of acute infection-induced encephalopathy type 9. This case highlights the importance of considering genetic susceptibility in children with recurrent infection-triggered encephalopathy and atypical recovery.
Japanese spotted fever (JSF) is an endemic tick-borne rickettsiosis in Japan that can cause severe illness and organ failure. Because early tetracycline therapy is crucial for improving outcomes, clarifying the clinical profile of JSF in endemic communities with an aging population and quantifying the impact of treatment delay are clinically important. We aimed to describe the clinical characteristics of patients with polymerase chain reaction (PCR)-confirmed JSF in an endemic region and to evaluate whether delays from symptom onset to minocycline initiation were associated with severe outcomes. We conducted a retrospective cohort study in patients with PCR-confirmed JSF admitted to a tertiary hospital in eastern Hiroshima Prefecture between 2011 and 2023. Time intervals were calculated using calendar dates, with same-day events coded as 0 days. The primary outcome was severe JSF, defined as the need for invasive mechanical ventilation and/or renal replacement therapy. Logistic regression was used to assess associations between onset-to-minocycline delay and severe outcomes, adjusting for age and sex. Forty-two patients (median age, 73.5 years) were included. Severe outcomes occurred in 13 patients (31.0%), and 6 patients (14.3%) died during hospitalization. The median onset-to-minocycline interval was longer in severe cases than in non-severe cases (6.0 vs. 4.0 days; p = 0.035). In multivariable analysis, each 1-day delay in minocycline initiation was associated with higher odds of severe outcomes (adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.81; p = 0.043). In this region with endemic JSF and with an older patient population, longer delays from symptom onset to minocycline initiation were associated with severe outcomes. Strategies to shorten onset-to-treatment intervals, including timely clinical examination and empiric tetracycline therapy when JSF is suspected, may improve outcomes in older communities with endemic JSF.
Diagnosis and management of cervical cancer require multiple investigations and specialist reviews, with delays leading to increased mortality and morbidity. Australia's Optimal Care Pathways (OCPs) recommends that patients with suspected diagnosis of cervical cancer should have their diagnostic processes completed within certain timeframes. Despite these guidelines, there is currently no benchmarking of cervical cancer timelines. This study aims to benchmark cervical cancer care and identify factors associated with delay. Patients who underwent radiotherapy for Stage I-III cervical cancer between 2015 and 2024 at a major tertiary hospital in New South Wales (NSW) were included in the study. This hospital provides centralised gynae-oncology care for all women in three NSW local health districts. Patients were stratified based on age, stage of disease, level of rurality and level of socioeconomic advantage/disadvantage. Each step of the diagnostic timeline was benchmarked against the OCPs. Univariate and multivariate logistic regression were performed to detect factors associated with delays. The study cohort comprised 155 patients. Under 60% of women were managed in-line with the OCPs recommended timelines. 86% (n = 19/22) of women from the least disadvantaged socio-economic tertile saw a gynae-oncology specialist within the recommended timeframe compared to 47% (36/76) from the most disadvantaged socio-economic tertile (OR: 6.24, CI: 1.60-24.27, p = 0.008). Recommended diagnostic timelines were not met in a significant proportion of women. Women from the greatest levels of socioeconomic disadvantage were more likely to face delays. Benchmarking processes need to be implemented in cancer care, to ensure equity in outcomes/processes for all patients.
Endometriosis is challenging to diagnose due to its nonspecific symptoms and the lack of reliable non-invasive methods. This study evaluates the diagnostic accuracy of Endotest©, a salivary microRNA test, by comparing its performance to laparoscopy. Additionally, it examines its ability to detect deep infiltrating endometriosis. In an exploratory attempt, we also conducted postoperative Endotest© to evaluate the consistency of results after surgery. A prospective study was carried out in women undergoing laparoscopy for suspected endometriosis. Preoperative saliva samples were collected and analyzed using Endotest©. A second Endotest© was performed postoperatively in patients with confirmed endometriosis. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated in this off-label setting and compared to radiologic methods in case of deep infiltrating endometriosis. Misclassification factors and potential changes in microRNA expression after surgery were also analyzed. Among 134 participants, 120 had endometriosis confirmed by laparoscopy. Compared to laparoscopy, preoperative Endotest© showed an accuracy of 73%, with sensitivity of 78% and specificity of 33% in this highly preselected patient cohort. For deep infiltrating endometriosis, the diagnostic accuracy of 49% for Endotest© was inferior to radiologic methods. Postoperative Endotest results were inconsistent, with 18 of 84 cases showing discordant findings between pre- and post-surgical testing. Endotest demonstrated high sensitivity but low specificity in this off-label analysis, limiting its use as a standalone diagnostic tool in this highly preselected patient cohort. The variability in postoperative Endotest© results suggests that microRNA expression may change after surgery. Further studies are needed to determine its role in clinical practice.
Women with coronary artery disease (CAD) typically have less severe stenosis and lower plaque burden than men but have disproportionately high adverse cardiovascular event rate. This study evaluated sex-based differences in quantitative plaque burden and its association with ischemia. A post-hoc exploratory analysis of the CREDENCE trial included 612 symptomatic patients (184 women, 428 men) with suspected stable CAD who underwent CCTA and invasive coronary angiography with fractional flow reserve (FFR) measurements. Total, calcified, and total non-calcified plaque burden and volume were quantified. Ischemia was defined as FFR ≤0.8. Women were older (66.5 ± 9.1 vs. 63.5 ± 10.3 years, p = 0.001) with lower prevalence of smoking. They exhibited less high-risk plaque, shorter lesion length, and lower stenosis severity. Plaque burden and volume were significantly lower in women across all components (all p < 0.05), except for calcified plaque burden. A 5% increase in plaque burden was significantly associated with ischemia in women for total plaque (OR = 1.28, 95% CI [1.12-1.46], p < 0.001), calcified plaque (OR = 1.31, 95% CI [1.10-1.57], p = 0.003), and total non-calcified plaque (OR = 1.33, 95% CI [1.05-1.67], p = 0.017). In men, only total and total non-calcified plaque burden were significant predictors of ischemia. Significant sex interactions were observed for total (p = 0.015) and calcified plaque burden (p = 0.046), indicating differential effects in women and men, but not for diameter stenosis (p = 0.928). Despite having a lower overall plaque burden, women exhibit a stronger association between plaque burden and ischemia than men. Further investigation in prospective studies is warranted to better understand potential sex-related differences in CAD.
We describe two cats with diabetes mellitus and Cushing's syndrome. Diabetes mellitus was initially managed with insulin glargine (Lantus; Sanofi-Aventis, Paris, France), nutritional therapy and continuous glucose monitoring. Hypercortisolism was suspected based on severe hypertension (Case 1), and insulin resistance in combination with typical clinical features of Cushing's syndrome (Case 2). Endocrine testing revealed non-suppressible cortisol concentrations on low-dose-dexamethasone suppression test, elevated endogenous adenocorticotrophic hormone (ACTH) concentration and pituitary enlargement on computed tomography. Cabergoline (Holiday®, Holliday-Scott S.A., Buenos Aires, Argentina) was initiated at a dose of 10 μg/kg po every 48 hours targeting both the pituitary tumour and hypercortisolism. In Case 2, the cabergoline dosage was gradually increased to a final dose of 10 μg/kg po every 12 hours. Both cats achieved diabetic remission within 1 and 6 months of treatment, respectively. Serial monitoring demonstrated a decrease in endogenous ACTH concentrations and a reduction in pituitary volume of 29% of baseline (Case 1) and of 52% of baseline (Case 2) after 8 months of treatment. These findings suggest that cabergoline may be a potential medical treatment option in cats with pituitary-dependent hypercortisolism.