Annals of Translational Medicine

Rapid prediction of the severity of acute coronary syndrome (ACS) is crucial for appropriate intervention in emergency department. Neutrophils (Neu), lymphocytes (Lym) and monocytes (Mon) and their ratios (Neu/Lym, NLR; Mon/Lym, MLR NeuxMon/Lym, SIRI) are acknowledged to be associated with the prediction of the severity and adverse outcome of ACS patients. Here, we analysed retrospectively eosinophils (Eos) and Eos-derived novel ratios (Neu/Eos, NER; Mon/Eos, MER; Neu x Mon/Eos, SIII; Neu/Eos x Lym, NEL; Mon/Eos x Lym, MEL; Neu x Mon/Eos x Lym, SV) of first admitted 1053 ACS patients within 24 hours of symptom onset to predict ST-segment elevation of myocardial infarction (STEMI), high Gensini score (H) and cardiac dysfunction (Killip Classification l to III grades). Results showed that Eos was significantly decreased in ST (n=227), Gensini (H) (n=311) and Killip I group (n=237) (P<0.05). All Eos-derived ratios (NER, MER, SIII, NEL, MEL, SV) were significantly higher with diagnostic severity (ST, Gensini (H), and Killip I group (P<0.05). ROC analysis revealed that SIII and SV predicted ST and Gensini (H) with high specificity and sensitivity, which were similar to that of NLR, MLR and SIRI. Conclusion: Eos and Eos-derived ratios, SIII and SV in particular, are strongly linked to the prediction of the severity of ACS, along with those of well-established leukocyte ratios. The new ratios of Eos hold significant importance in emergency department for quick evaluation of ACS patients.

PurposeTo evaluate the three-year efficacy and safety of compound trabeculectomy for uveitic glaucoma (UG). MethodsThis retrospective study enrolled 51 patients (53 eyes) requiring compound trabeculectomy, divided into UG (25 eyes) and non-UG groups (28 eyes). Outcomes including intraocular pressure (IOP), medication use, surgical success rates, and complications were analyzed over 3 years. ResultsBaseline characteristics including age, sex, preoperative IOP and medication use were comparable (all P>0.05). At 36 months, postoperative IOP was showed no significant differences, which was 15.4{+/-}8.4 mmHg and 14.6{+/-}3.3 mmHg (P=0.73) with 54% and 55% reduction (P=0.88) in UG and non-UG groups respectively. The qualified success rate was 76.0% and 85.7% at 36 months in UG and non-UG group, and Kaplan-Meier analysis showed no significant difference. Medication reduction of UG group was significant lower than non-UG group (P=0.0058). Comparable complication rates were observed between groups (all P>0.05), yet bleb scarring and cataract progression showed elevated incidence in both cohort. ConclusionCompound trabeculectomy effectively reduced IOP and medications use in UG and non-UG. There was no significant difference in both qualified and completed success rate between UG and non-UG. Complications of filtering bleb fibrosis and cataract progression should be pay close attention for both groups.

BackgroundQuality of life (QoL), the highest prioritised outcome by children with bronchiectasis and their parents, is a patient-reported outcome measure increasingly considered essential when evaluating health and interventions. Despite this, there are no validated instruments that specifically measure QoL related to bronchiectasis in children. We aimed to develop and validate a new bronchiectasis child-specific parent-proxy QoL instrument (BC-QoL). MethodsWe developed a draft 44-item BC-QoL and subsequently conducted a prospective cohort study where 142 parents completed draft BC-QoL and six other measures: two validated cough scores, parent-proxy childrens acute cough-specific QoL, depression, anxiety and stress 21-item scale, RAND-36 and paediatric QoL (PedsQLTM4.0) to assess the convergent and discriminant validity of the BC-QoL. The questionnaires were completed over three weeks at different phases of their childs illness (stable state, exacerbation and/or recovery). Responses were analysed using psychometric and clinical impact techniques to reduce items and determine the instruments reliability and validity. Minimally important difference (MID) was also calculated. ResultsThe final 23-item BC-QoL instrument with its three domains (emotional, physical, social well-being) demonstrated high split half reliability (0.95), Cronbachs alpha (0.97), repeatability (intraclass coefficient=0.74, 95%CI 0.62-0.82), validity and responsiveness. BC-QoLs domains significantly correlated with that of PedsQLTM4.0 (Spearman correlations: emotional=0.43, social=0.41, physical=0.47). BC-QoLs MID ranged from 0.74 to 1.32. ConclusionBC-QoL, the first bronchiectasis child-specific QoL instrument, has evidence demonstrating its validity and reliability, and can be used to evaluate the impact and effectiveness of interventions and better understand the disease burden in children with bronchiectasis.

ObjectiveThis study aimed to evaluate the efficacy, safety, and optimal strains of probiotics for pediatric allergic rhinitis (AR) using meta-analysis and network meta-analysis. MethodsA systematic search was conducted in databases including PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure up to July 31, 2025, to identify randomized controlled trials (RCTs). Inclusion criteria were pediatric patients with AR, probiotic interventions, control groups receiving placebo or standard treatment, and reported outcomes such as Total Nasal Symptom Score (TNSS), Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), serum IgE levels, clinical efficacy, or adverse events. Study quality was assessed using the JADAD scale, with meta-analysis and network meta-analysis (NMA) performed via RevMan and R software, calculating standardized mean differences (SMD), relative risks (RR), and surface under the cumulative ranking curve (SUCRA) values. ResultsTwenty-six RCTs were included, involving 3,014 patients (1,565 in the probiotic group and 1,404 in the control group). Meta-analysis showed that probiotics significantly reduced TNSS (SMD = -0.85, 95% CI [-1.25, -0.44], P < 0.05), improved PRQLQ scores (SMD = -3.94, 95% CI [-4.55, -3.33], P < 0.05), enhanced clinical efficacy (RR = 1.16, 95% CI [1.07, 1.25], P < 0.05), and decreased adverse events (RR = 0.22, 95% CI [0.06, 0.82], P < 0.05), but exerted no overall effect on serum IgE (SMD = -0.39, 95% CI [-0.99, 0.09], P = 0.11). Subgroup and NMA analyses indicated that mixed strains performed superiorly across multiple outcomes. ConclusionsProbiotics, particularly mixed strains, are a safe and effective adjunctive therapy for pediatric AR, improving symptoms and quality of life. Large-scale RCTs are required to validate optimal regimens.

BackgroundLarge-scale CT-based reference standards for abdominal organ volume, incorporating age, sex, and body size, are limited. PurposeTo establish sex- and age-specific reference distributions for major abdominal organ volumes on non-contrast abdominopelvic CT in a nationwide Japanese cohort to provide a foundation for automated clinical assessment and dose optimization. Materials and MethodsIn this retrospective, multicenter study, using the Japan Medical Image Database, we identified all non-contrast abdominopelvic CT examinations performed in 2024. Unique adults with available data on age, sex, height, and weight were included in this study. The final sample comprised 49,764 examinations (26,456 men and 23,308 women) conducted at nine institutions. Automated segmentation (TotalSegmentator v2.10.0) was used to produce organ volumes, excluding hollow viscera. The sex-specific 10th, 25th, 50th, 75th, and 90th percentiles were calculated. Age-volume relationships of body surface area (BSA)-normalized volumes (mL/m2) were modeled using natural cubic splines (four degrees of freedom) separately by sex. ResultsMedian (mL) male vs female volumes were as follows: liver, 1194.7 vs 1024.0; pancreas, 63.6 vs 52.2; spleen, 118.1 vs 95.1; kidneys (total), 268.3 vs 221.2; adrenals (total), 6.6 vs 4.2; iliopsoas (total), 483.4 vs 317.7; prostate, 24.9 (men only). Age-volume relationships of BSA-normalized volumes showed convex patterns for the liver, pancreas, and kidneys in both sexes and for male adrenal glands; lower values in older age groups for the spleen and iliopsoas in both sexes; and higher values in older age groups for the prostate and female adrenal glands. ConclusionThis nationwide Japanese CT cohort provides sex- and age-resolved volumetric reference standards. These standards enable objective identification of abnormalities, support personalized medicine, and facilitate automated AI-based reporting to reduce radiologist workload and optimize radiation dose protocols. Key ResultsO_LIMedian volumes (men vs women, mL): liver 1195/1024; pancreas 64/52; spleen 118/95; kidneys 268/221; adrenals 6.6/4.2; iliopsoas 483/318; prostate 25. C_LIO_LIBody surface area-normalized age-volume relationships were convex for liver, pancreas, and kidneys in both sexes and for male adrenal glands. C_LIO_LISpleen and iliopsoas declined monotonically with age in both sexes, whereas prostate and female adrenal glands increased monotonically. C_LI

ObjectivesTo evaluate the efficacy and safety of sitafloxacin-containing regimens versus non-sitafloxacin therapy in patients with nontuberculous mycobacterial (NTM) pulmonary disease, focusing on sputum/BALF conversion rate, time of sputum/BALF culture conversion and radiographic improvement. MethodsThis retrospective cohort study analyzed 149 adults (76 control group vs. 73 sitafloxacin group) with NTM pulmonary disease treated between 2021 to 2024. Inclusion criteria: (1) Sitafloxacin group: [&ge;] 3 months of sitafloxacin-based therapy; (2) Both groups: Confirmed diagnosis of NTM pulmonary disease and age [&ge;] 18 years old. Exclusion criteria: extrapulmonary/disseminated NTM, HIV, active tuberculosis, or incomplete clinical data. Primary endpoint: culture conversion rate and time to culture conversion. Secondary endpoints: radiographic improvement and adverse events (AEs). ResultsThe sitafloxacin group demonstrated significantly higher conversion rate (53.8% vs. 22.1%, P 0.001) and faster culture conversion than the control group without sitafloxacin (median 195 vs. 292 days, P 0.001). Radiographic improvement was more frequent with the sitafloxacin group (54.5% vs. 36.1%, P = 0.046). Compared to the control group, the sitafloxacin group exhibited no significant adverse events. ConclusionsSitafloxacin-based regimens accelerate microbiological clearance and promote radiographic healing in NTM pulmonary disease with good safety, positioning it as a viable drug for improved treatment of NTM infections.

IntroductionPediatric acute appendicitis (PAA) remains challenging to diagnose despite existing diagnostic scores. The BIDIAP index is a three-item diagnostic tool with very high discriminative performance in a derivation cohort. This study aimed to prospectively and externally validate the BIDIAP index in a multicenter pediatric population. Material and MethodsWe conducted a prospective, multicenter observational study across four tertiary pediatric centers, enrolling children presenting with suspected PAA. Two groups were analyzed: patients with histopathologically confirmed PAA and patients in whom appendicitis was confidently excluded after diagnostic work-up, classified as non-surgical abdominal pain (NSAP). The BIDIAP index was applied using a predefined cutoff ([&ge;] 4 points), and diagnostic performance was assessed using ROC analysis, calibration metrics, and decision curve analysis (DCA). ResultsA total of 644 patients meeting the prespecified analytical criteria were included in the primary analysis. The BIDIAP index demonstrated excellent diagnostic performance, with an area under the ROC curve of 0.93 (95% CI, 0.92-0.95). The calibration slope was 1.00, and the intercept was close to zero, indicating close agreement between predicted and observed risks. At the prespecified cutoff value of [&ge;] 4 points, the BIDIAP index achieved a sensitivity of 90.5% and a specificity of 81.6%. DCA showed a positive net clinical benefit of the BIDIAP index over treat-all and treat-none strategies across the full range of clinically relevant threshold probabilities. ConclusionsThe BIDIAP index demonstrated excellent diagnostic performance for PAA. Its simplicity, based on only three items, and its potential applicability even when the appendix is not visualized on ultrasonography make the BIDIAP index a promising tool for supporting clinical decision-making in routine pediatric emergency practice.

OBJECTIVESAlthough several systematic reviews attempted to compare supraglottic airway (SGA) and endotracheal intubation for or adults with out-of-hospital cardiac arrest (OHCA), the optimal airway management strategy remains debated. We conducted a systematic review and meta-analysis comparing supraglottic airway (SGA) devices and endotracheal intubation (ETI) as initial interventions in OHCA to clarify their relative clinical efficacy. DATA SOURCESWe retrieved relevant clinical trials from PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure(CNKI), as well as unpublished sources, from inception to October 10, 2025. STUDY SELECTIONWe included randomized controlled trials (RCTs) and non-randomized studies involving adult patients with OHCA who were assigned to supraglottic airway (SGA) versus endotracheal intubation for initial prehospital airway management. RESULTSOur systematic review and meta-analysis enrolled 9 randomized controlled trials and 23 non-randomized studies, involving 196,573 patients. Patients who received SGA were associated with higher incidence of return of spontaneous circulation (ROSC), (RCT RR = 1.17, 95% CI: [1.03,1.34], P = 0.016, I{superscript 2} = 48.5%), higher incidence of first-attempt success rates (RCT: RR = 1.31, 95% CI, [1.14-1.51], P = 0.0029. Non-RCTs: RR = 1.46, 95% CI: [1.26,1.70], P < 0.0001, I{superscript 2} = 83.1%), higher incidence of return of time to airway securement (RCT: MD = -2.30 min, 95% CI: [-3.54, -1.05], P = 0.0003, I{superscript 2} = 98.4%. Non-RCTs: MD = -2.86 min, 95% CI: [-3.62, -2.11], P < 0.0001, I{superscript 2} = 95.8%.). There is no difference in favorable neurological outcome (RCT: RR = 1.06, 95% CI: [0.84, 1.35], P = 0.6202, I{superscript 2} = 45.4%. Non-RCTs: RR = 0.94, 95% CI: [ 0.76, 1.18], P = 0.6198, I{superscript 2} = 74.2%.) and no difference in occurrence of regurgitation/aspiration (RR 1.03; 95% CI: [0.93, 1.14]; P=0.5426, I{superscript 2} = 0.0%). Additionally, trial sequential analysis was performed to validate these findings. CONCLUSIONFor adult patients experiencing out-of-hospital cardiac arrest (OHCA), initial airway management by using supraglottic airway (SGA) improves rate of return of spontaneous circulation (ROSC), enables faster airway placement, and achieves higher first-pass success rate when compared with endotracheal intubation. There is a high degree of certainty regarding the major outcomes.

ObjectiveTo compare the efficacy and safety of etomidate versus ketamine as induction agents for rapid sequence intubation in critically ill adults, focusing on 28-day mortality and post-intubation hypotension. Data SourcesPubMed, Embase, and the Cochrane Library were systematically searched from inception to January 2026. Reference lists of included studies were also manually screened. Study SelectionWe included randomized controlled trials (RCTs) comparing single-dose intravenous ketamine versus etomidate for emergency rapid sequence intubation in critically ill adults ([&ge;] 18 years) in non-operating room settings (e.g., intensive care unit or emergency department). Data ExtractionTwo investigators independently screened records, extracted data using a standardized form and assessed the risk of bias using the RoB 2 tool. The certainty of evidence was evaluated using the GRADE framework. Data SynthesisSix RCTs comprising 4,108 patients (2,046 assigned to ketamine and 2,062 to etomidate) were included. The pooled analysis showed no statistically significant difference in 28-day mortality between the ketamine and etomidate groups (39.0% vs. 40.3%; relative risk [RR] 0.96; 95% CI, 0.89-1.03; p=0.29; I{superscript 2}=11%). In a prespecified subgroup analysis of patients with sepsis (n=1,546), mortality also did not differ significantly (RR 0.94; 95% CI, 0.86-1.03). However, ketamine was associated with a statistically significant increase in the incidence of post-intubation hypotension (14.2% vs. 11.3%; RR 1.25; 95% CI, 1.01-1.53; p=0.04; I{superscript 2}=0%). No significant differences were observed regarding peri-intubation cardiac arrest, first-attempt intubation success, or ventilator- and intensive care unit-free days. ConclusionsThere is no statistical difference in 28-day mortality between etomidate and ketamine for emergency intubation in critically ill adults, including those with sepsis. The higher incidence of post-intubation hypotension with ketamine suggests etomidate presents a more favorable hemodynamic safety profile in this setting. Key pointsO_ST_ABSQuestionC_ST_ABSDoes the choice between etomidate and ketamine for emergency intubation in critically ill patients impact 28-day mortality? FindingsIn this systematic review and meta-analysis of randomized controlled trials, there was no statistically significant difference in 28-day mortality between patients induced with ketamine (39.0%) and those induced with etomidate (40.3%). MeaningThe use of etomidate versus ketamine for rapid sequence intubation does not alter 28-day mortality, indicating that the choice of induction agent should be individualized.

ObjectivesTo investigate the factors associated with the deterioration of post-COVID-19 condition (PCC) symptoms in patients who received a dose of SARS-CoV-2 vaccine [&ge;] 90 days after their infection. MethodMulticenter cohort study conducted in 33 emergency departments across Canada, including 476 patients who developed PCC according to the World Health Organization definition. Data were collected via telephone questionnaires. Statistical analyses, including logistic regression models, were performed to identify factors associated with symptom deterioration after vaccination. ResultsAmong participants, 28.8% reported a deterioration of their PCC symptoms after vaccination. Two factors were significantly associated with this deterioration: receiving the Moderna (mRNA-1273) vaccine (aOR = 1.80; 95% CI: 1.14-2.8) and a persistent cough three months after the initial infection (aOR = 1.81; 95% CI: 1.03-3.15). No association was found between symptom deterioration and sociodemographic characteristics such as age or sex. ConclusionPost-infection vaccination may be associated with increased risk of PCC symptoms deterioration in some patients, particularly those vaccinated with Moderna (mRNA-1273) or presenting with a persistent cough. While the benefits of vaccination remain substantial, these findings call for further investigation into the underlying immunological mechanisms and possible adjustments to vaccination strategies for patients with PCC.

BackgroundBronchiectasis is a debilitating respiratory condition characterized by chronic cough with expectoration of thick sputum. It accounts for significant morbidity and mortality, especially when associated with exacerbations. Assessing the health-related quality of life (HR-QoL) of patients with bronchiectasis is important to ascertain the impact of the disease on day-to-day life, as well as to gauge the effect of targeted interventions. Conventionally used methods for assessing HR-QoL such as the St. Georges Respiratory Questionnaire (SGRQ) are time-consuming and have limitations in day-to-day application. The Bronchiectasis Health Questionnaire (BHQ) is a novel, compact tool used for assessing the HR-QoL, and has been validated for use in Korean and Turkish populations. MethodsWe attempted to develop and validate the Hindi version of the Bronchiectasis Health Questionnaire (BHQ) in Indian adults with bronchiectasis. We assessed the correlation between the Hindi BHQ (H-BHQ) scores and other measures of lung health including the Hindi version of the COPD Assessment Tool (H-CAT), pulmonary function tests and the bronchiectasis severity index (BSI). In addition, we assessed the correlation between the H-BHQ scores and the number of exacerbations and hospital admissions in the previous year. ResultsA total of 145 subjects with bronchiectasis were included. The mean ({+/-} SD) H-BHQ total score was 49.10 {+/-} 10.3. The H-BHQ score correlated well with the H-CAT score (Correlation coefficient -0.6534, p value < 0.0001) and the mMRC scale (Correlation coefficient of -0.4459,p value < 0.0001). The H-BHQ score also had a moderate correlation with the number of exacerbations and low correlation with hospital admissions in the previous year, with correlation coefficients of -0.4193 (p < 0.0001) and -0.3030 (p < 0.0001), respectively. The correlation between the H-BHQ and the Bronchiectasis Severity Index (BSI) score was weak (Correlation coefficient of -0.3012, p value < 0.01). ConclusionThe H-BHQ offers a simple and convenient method to assess the HR-QoL in patients with bronchiectasis, and correlates well with other measures of respiratory health, including the H-CAT, the mMRC score and the number of exacerbations and hospital admissions in the previous year.

IntroductionCentral line-associated bloodstream-infection (CLA-BSI) and catheter-related bloodstream infections (CR-BSI) remain a significant concern in pediatric inpatient units. ObjectiveTo analyze a case series of CLA-BSI and CR-BSI in hospitalized pediatric patients in hospitals with rigorous infection prevention measures. Materials and MethodsThis was an analytical, descriptive, and retrospective study conducted in patients aged 0 to 18 years, admitted between August 2023 and March 2025, with a diagnosis of CLA-BSI or CR-BSI in two pediatric hospitals in Rio de Janeiro, Brazil. Variables potentially associated with the occurrence of infection were analyzed. ResultsA total of 86 infections were evaluated, comprising 66 CLA-BSI and 20 CR-BSI. Sixty patients (69.8%) were male, with a mean age of 71.8 months. Sixty-five (83.7%) had previous comorbidities, 63 (73.2%) had a prior hospitalization, and 27 (31.4%) had another invasive device. The mean time from catheter insertion to infection diagnosis was 32.1 days, and the mean time from hospital admission to infection onset was 18.45 days. Gram-negative bacteria were isolated in 40/86 (46.5%) cases. At 30 days post-infection, 61/86 (70.9%) had been discharged, 20/86 (23.3%) remained hospitalized, and 5/86 (5.8%) had died. There was no correlation between the bacterial group and the type of catheter used (p=0.068), nor between infection type (CLA-BSI vs. CR-BSI) and mortality outcome (p=1). ConclusionsCLA-BSI and CR-BSI occurred predominantly in patients with prolonged hospital stays and underlying comorbidities, and were mainly caused by Gram-negative bacteria.

IntroductionChildhood asthma remains a major public health challenge in low- and middle-income countries, where social and economic factors influence disease outcomes. This study examined the sociodemographic determinants of asthma exacerbation among children attending clinic at Thika Level 5 Hospital, Kenya. MethodsThis study employed a hospital-based cross-sectional study involving 108 caregivers- child dyads, each consisting of a child with confirmed asthma and their primary caregiver. The dyads were recruited from the pediatric asthma clinic from 31st March 2025 to 30th April 2025 then follow up was conducted for six months form 1st May to 31st October 2025. Data were collected using structured questionnaires and clinic records. Descriptive statistics summarized sociodemographic characteristics, while chi-square tests and logistic regression assessed associations between caregiver factors and asthma control. ResultsThe mean age of children was 8.1 years (range 3-17), with males comprising 57.4%. Most caregivers were mothers (88%), had secondary education (57.4%), and were in informal employment (75.9%). Household income was low for 59.3% of participants (<KES 30,000/month). Caregiver education (AOR=2.8; 95% CI:1.5-5.2; p=0.001) was the strongest predictor of asthma control, followed by medical insurance ({chi}2=10.41; p=0.001). Formal employment and higher income were significantly associated with controlled asthma ({chi}2=6.45; p=0.04 and {chi}2=9.72; p=0.02 respectively). Urban residence modified the positive effect of education on asthma management (interaction AOR=1.9; p=0.03). ConclusionCaregiver education level, employment, income, and medical insurance significantly influence asthma control among children. Enhancing health literacy and expanding insurance coverage under the Social Health Authority (SHA) can improve asthma outcomes in Kenyan children.

Withdrawal StatementThe authors have withdrawn this manuscript because it will undergo major modifications and revisions to improve accuracy and clarity. Therefore, the authors do not wish this work to be cited as a reference for the project. If you have any questions, please contact the corresponding author.

PurposeTo investigate whether the geometric shape of the globe, sagittal length (SL) and Posterior Radius of curvature (rPC), differ between patients with rhegmatogenous retinal detachment (RD) and macular hole (MH), and to determine if these parameters offer better diagnostic differentiation than axial length (AL) alone. MethodsThis retrospective study included 20 MH and 20 RD patients. Groups were axial-length matched. Ocular biometry was performed with ultrasound to measure AL and SL. The PR was calculated. Due to the non-normal distribution of the data, the Mann-Whitney U test was used for continuous variables and Fishers Exact Test for gender distribution. ResultsThere was no significant difference between the MH and RD groups in terms of age (median: 33.8 vs 32.6 years; p=1.00), gender (p=0.341), or AL (27.65 mm vs 28.58 mm; p=0.39). However, RD eyes showed significantly higher SL (median: 25.70 mm vs 22.90 mm; p=0.001) and a significantly flatter rPC (median: 28.25 mm vs 24.30 mm; p < 0.001). ConclusionRD eyes exhibit a distinct vertical equatorial expansion and posterior flattening that is not present in MH eyes, despite similar axial lengths. These geometric differences suggest that SL and PR are structural risk factors in vitreoretinal disease.

Pneumocystis jirovecii Pneumonia (PJP) is a potentially life-threatening fungal infection occurring in immunocompromised individuals, particularly those receiving anti-cancer treatment. However, the incidence of PJP among children and young people (CYP) with cancer, cancer-like conditions or haematopoietic stem cell transplant (HSCT) recipients is unclear. This systematic review aimed to determine the incidence and impact of PJP in this population. Twelve databases were searched in November 2024. Any study reporting the incidence of PJP in CYP<18 years old with cancer, a cancer-like condition or having received a HSCT were included. Screening, data extraction and quality assessment (using a modified JBI critical appraisal tool for prevalence studies) were conducted in duplicate. Meta-analyses using GLMM methods were used. Of 7,194 records screened, 106 studies were included. Interpretation of the results of many studies was hindered by limited reporting. For the acute lymphoblastic leukaemia meta-analyses using confirmed events, higher pooled cumulative incidence rates were seen in the no prophylaxis group than in the prophylaxis group (2.86% vs 0.04%). Rates increased to 5.41% in the no prophylaxis group when studies reporting unconfirmed cases were included. Subgroup analyses suggested lower incidence rates in cohorts taking first-line PJP prophylaxis, compared to second-line. The cumulative incidence rate using confirmed events was 0.16% for HSCT patients receiving prophylaxis; data were not available for a no prophylaxis analysis. Only three studies were available for the HSCT total events analysis, producing a rate of 4.27%. Several analyses were subject to some uncertainty due to their high heterogeneity estimates. PROSPERO registration: CRD42025628682

PurposeTo evaluate the efficacy and safety of Gene III L-ergothioneine (EGT) Eye Care Solution for alleviating ocular discomfort in patients with dry eye syndrome (DES). MethodsIn this single-center, randomized, open-label, self-controlled trial, 40 DES patients were randomly assigned in a 1:1 ratio to one of two treatment groups: Group 1 received the Gene III EGT Eye Care Wash Solution via an eye wash cup (5 mL/vial), and Group 2 received the same formulation as Gene III EGT Eye Care Drops Solution (0.5 mL/vial). Outcomes were assessed at baseline and after 14 days using validated scales, including the Chinese Dry Eye Questionnaire, the Ocular Surface Disease Index (OSDI), and the Comprehensive Assessment of Visual Fatigue (CAVF), along with fluorescein tear film break-up time (TBUT). ResultsCombined analysis (N = 40) demonstrated significant improvements in dry eye symptoms with mean scores decreasing from 12.50 to 10.65 (P = 0.0353). Ocular Surface Disease Index (OSDI) scores improved from 12.25 to 9.2 (P = 0.0309), and visual fatigue, assessed by the CAVF scale, decreased from 11.18 to 6.60 (P = 0.0008). Significant increases in TBUT were observed in both groups, with left eye first TBUT rising in Group 1 (P = 0.0199) and Group 2 (P < 0.0001). No treatment-related adverse events were reported. ConclusionGene III EGT Eye Care Solution effectively alleviated DES symptoms and demonstrated a favorable safety profile. Larger placebo-controlled trials are warranted to confirm these findings.

BackgroundSevere Fever with Thrombocytopenia Syndrome (SFTS) is an acute infectious disease with high mortality. This study aimed to develop a quantitative scoring system for grading SFTS severity using dynamic clinical data. MethodsA retrospective study included 547 confirmed SFTS patients from two hospitals. Clinical data were collected over a 14-day course (divided into four phases). Patients were grouped into survivors (n=451) and non-survivors (n=96). Statistical analyses, including Kaplan-Meier curves and log-rank tests, were performed. An external validation cohort of 44 new patients was used to validate the scoring system via C-statistic, calibration curves, and decision curve analysis (DCA). ResultsOf 547 patients, 96 (17.55%) were non-survivors. Multivariate logistic regression identified six independent prognostic factors across phases: age, platelet (PLT), aspartate aminotransferase (AST), and creatinine (Cr) (days 5-7); age, red blood cell distribution width (RDW), Cr, and lactate dehydrogenase (LDH) (days 8-10); Cr and LDH (days 11-14). A scoring system (0-11 points) was developed, stratifying patients into low (0-3), intermediate (4-7), and high (8-11) risk groups, with adverse outcome rates of 1.04%, 22.92%, and 76.04%, respectively. Kaplan-Meier curves showed significant prognostic differences (log-rank P<0.001). External validation (44 cases) confirmed excellent performance: AUC 0.810-0.952, good calibration (Hosmer-Lemeshow P>0.05), and net clinical benefit (DCA Eavg 0.068-0.098, Emax 0.422-0.559). ConclusionA dynamic SFTS severity scoring system was developed and validated. Internal and external validation confirmed its reliability and clinical utility, providing a simple, practical tool for timely assessment and early intervention.

BackgroundAccurate differentiation of benign and malignant focal liver lesions (FLLs) is essential for clinical decision-making. Magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI) are advanced MRI techniques used for noninvasive lesion characterization, but their comparative diagnostic performance has not been definitively established. ObjectiveTo systematically compare the diagnostic accuracy of MRE and DWI for distinguishing benign from malignant FLLs. MethodsA systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, and Scopus were searched through July 2025 for studies directly comparing MRE and DWI in the same patient cohorts with focal liver lesions, using histopathology or validated imaging follow-up as the reference standard. Sensitivity, specificity, and area under the curve (AUC) were pooled using bivariate random-effects models, with paired analysis to compare modalities. Results219 patients with 284 focal liver lesions were analyzed. MRE demonstrated higher pooled sensitivity (93.8%, 95% CI: 85.6-97.5) and specificity (89.9%, 95% CI: 74.6-96.4) than DWI (sensitivity 86.2%, 95% CI: 80.5-90.5; specificity 83.4%, 95% CI: 74.3-89.8). MRE also had a higher AUC (0.97 vs. 0.88). Likelihood ratio analysis indicated MREs stronger ability to both confirm and exclude malignancy. Paired meta-analysis confirmed a statistically significant increase in sensitivity for MRE (relative sensitivity 1.09; p = 0.018), with no significant difference in specificity. ConclusionMRE demonstrates superior sensitivity and overall diagnostic accuracy compared to DWI for differentiating benign and malignant FLLs. Further large-scale prospective studies are needed to confirm these results and determine optimal cutoff values to guide clinical decision-making.

IntroductionHyperferritinemia is a prognostic marker in critical illness, but its role in postoperative outcomes of pediatric congenital heart defects remains poorly defined, especially in resource-limited settings. This study evaluated early serum ferritin as a predictor of outcomes after congenital heart surgery and its association with the PIM 3 score. MethodsA single-center, prospective cohort study was conducted from April 2023 to October 2024 at a tertiary referral center in southeastern Brazil. Patients aged 29 days to 18 years, of both sexes, admitted to the PICU after congenital heart surgery were included and categorized as cyanotic or acyanotic. Statistical significance was defined as two-sided p < 0.05. ResultsA total of 105 patients were included. Median ferritin was higher in patients with PICU stays < 7 days (183 ng/mL; p = 0.004) and was significantly associated with a PIM 3 score [&ge;] 5% (642 ng/mL; p < 0.006). Cyanotic patients had longer PICU stays (11.0 vs. 7.2 days; p = 0.02), longer use of vasoactive drugs (3.8 vs. 2.6 days; p = 0.01), and accounted for all deaths (p < 0.001). Hemoglobin and hematocrit were also significantly higher in cyanotic patients (14 vs. 13 g/dL and 40% vs. 37%; p < 0.001). ConclusionsSerum ferritin may serve as a marker of secondary outcomes and aid early risk stratification in congenital heart defects patients in the PICU.