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Background and aims: Traditionally, low molecular weight heparin, such as dalteparin, has been the first-line treatment for cancer-associated venous thromboembolism (VTE). However, recent studies suggest that rivaroxaban, a direct oral anticoagulant, may offer comparable efficacy with the convenience of oral administration. This systematic review and meta-analysis aim to evaluate and compare the efficacy and safety of rivaroxaban versus dalteparin in managing cancer-associated VTE, focusing on recurrence rates, bleeding events, and patient adherence. Methods: This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines, systematically retrieving data from PubMed and Cochrane databases using structured search terms related to cancer, VTE, and anticoagulation. Data on recurrent VTE, major bleeding, and patient outcomes were extracted. Statistical analyses were performed using a random-effects model to account for heterogeneity. Results: Nine studies were analyzed, encompassing a range of study designs across multiple countries. The findings show no significant difference in major bleeding risk between rivaroxaban and dalteparin (risk ratio: 0.91, P = 0.69), nor in bleeding-related mortality (odds ratio [OR]: 4.00, P = 0.36). Rivaroxaban was associated with a significant reduction in deep vein thrombosis (DVT) recurrence (OR: 0.75, P = 0.04) and a marginally nonsignificant reduction in pulmonary embolism recurrence (OR: 0.73, P = 0.05). Nonsignificant bleeding events were slightly higher with rivaroxaban but did not reach statistical significance. Conclusion: Rivaroxaban presents a viable alternative to dalteparin for treating cancer-associated VTE, showing comparable safety regarding major bleeding and potential efficacy in reducing DVT recurrence. This study supports the potential for more standardized guidelines that include rivaroxaban as a feasible option in cancer-associated VTE management.

Case: Three cases of pediatric patients with knee injuries from cactus thorns are included. These cases are variable in presentation ranging from acute inflammatory responses to permanent limb deformity secondary to growth arrest. Definitive treatment also varied widely from nonoperative conservative management to multiple arthroscopic and open surgeries. Conclusion: Pediatric cactus thorn injuries have varied presentations, requiring a high level of clinical suspicion for diagnosis and treatment to prevent permanent damage.

Background Brain arteriovenous malformations (AVMs) are abnormal connections between feeding arteries and draining veins, associated with significant risks of haemorrhage, seizures and other neurological deficits. Preoperative embolization is commonly used as an adjunct to microsurgical resection, with the aim of reducing intraoperative complications and improving outcomes. However, the efficacy and safety of this approach remain controversial. Methods This study is a subanalysis of the Multicenter International Study for Treatment of Brain AVMs consortium. We retrospectively analysed 486 patients with brain AVMs treated with microsurgical resection between January 2010 and December 2023. Patients were divided into two groups: those who underwent microsurgery alone (n=245) and those who received preoperative embolization, followed by microsurgery (n=241). Propensity score matching was employed, resulting in 288 matched patients (144 in each group). The primary outcomes were rates of complete AVM obliteration and functional outcomes (measured by the modified Rankin Scale (mRS)). Secondary outcomes included complication rates, mortality, hospital length of stay and postsurgical rupture. Results After matching, the complete obliteration rate was 97% with no significant difference between the microsurgery-only group and the preoperative embolization group (p=0.12). The proportion of patients with an mRS score of 0–2 at the last follow-up was similar in both groups (83% vs 84%; p=0.67). The median hospital stay was significantly longer for the embolisation group (9 days vs 7 days; p=0.017). Complication rates (24% vs 22%; p=0.57) and mortality rates (4.9% vs 2.1%; p=0.20) were comparable between the two groups. No significant differences were observed in postsurgical rupture, recurrence or retreatment rates. Conclusions In this large multicentre study, preoperative embolization did not significantly improve AVM obliteration rates, functional outcomes or reduce complications compared with microsurgery alone.

Abstract Aims We recently demonstrated the combined prognostic value of the following two simple non-invasive parameters obtained from treadmill exercise testing in patients with heart failure (HF) with reduced ejection fraction: the Haemodynamic Gain Index (HGI) and peak rate-pressure product (RPP). However, their prognostic value is yet to be validated in patients with undifferentiated HF syndrome. Methods and results We identified consecutive HF patients undergoing treadmill exercise testing for symptom evaluation between January 1991 and February 2015. The HGI was calculated from [(SBPpeak × heart ratepeak) – (SBPrest × heart raterest)]/(SBPrest × heart raterest), and the peak RPP was calculated from SBPpeak × heart ratepeak. Hazard ratios per standard deviation increase of the HGI and peak RPP for all-cause mortality were estimated using multivariable Cox regression models with adjustment for traditional cardiovascular risk factors and exercise-testing parameters (Chronotropic Reserve Index, estimated metabolic equivalents, abnormal heart rate recovery, and total exercise time). In our cohort of 5940 patients with symptomatic HF diagnosis with a median follow-up of 7.1 years, 2222 (37.4%) patients died. Higher values of both HGI and peak RPP were associated with a lower risk of mortality [adjusted hazard ratio per standard deviation increase 0.80 (0.73–0.88) and 0.85 (0.78–0.91), respectively, all P < 0.001]. Optimal cut-off values for HGI and peak RPP for discriminating all-cause mortality were 1.06 and 180 966, respectively. Conclusion Both HGI and peak RPP are predictors of mortality in patients with chronic HF and may be tools to signal the need for advanced HF therapy evaluation.

Objectives: Cervical esophageal cancer (CEC) is an uncommon malignancy accounting for <5% of all esophageal carcinomas. Treatment of CEC varies and is adapted from established regimens used for squamous cell carcinoma (SCC) or the lower esophageal and head and neck. The present systematic review and guidelines are intended to assist treatment decision making for patients with CEC based on the available evidence. Methods: Using the Population, Intervention, Comparator, Outcome, Timing, and Study Design (PICOTS) framework, the evidence regarding treatment outcomes was assessed using Cochrane and PRISMA 2020 methodology. Eligible studies included prospective Phase II to III trials and retrospective analyses published between January 1, 2013 and February 23, 2024 in the Ovid Medline database. These references were assessed through the American Radium Society (ARS) Appropriate Use Criteria (AUC) methodology. A systematic review PRISMA 2020 checklist confirmed the completion of essential elements. RAND-UCLA consensus methodology was used by the expert panel to rate the appropriateness of the treatment options. Results: ARS AUC recommendations include (1) larynx preservation using endoscopic resection (EMR or ESD) alone for the typical case with pT1a cN0 cM0 CEC, (2) definitive CRT for the typical case with cT1bN0M0 in patients who cannot undergo endoscopic resection, (3) larynx-preserving using definitive CRT (with or without induction chemotherapy) for the typical case with nonmetastatic locally advanced CEC (advanced T-stage tumors or involved lymph nodes), with surgery reserved for those patients with incomplete response or locoregional recurrence. Conclusions: This ARS AUC summary provides guidelines for the management of SCC of the cervical esophagus provides based on available evidence. Topics that warrant further investigation include optimization of (1) patient selection; (2) multimodality therapies including chemotherapy, immunotherapy, and targeted agents; (3) radiation dose, schedule, and treatment volume; and (4) supportive care for patients with CEC. Ongoing trials continue to improve outcomes for patients with CEC.

AbstractBackgroundPhoton counting X‐ray detectors (PCDs) provide better spatial resolution than energy integrating X‐ray detectors, but even higher resolution is desired in some applications. Certain charge sharing compensation techniques such as coincidence counting preferentially detect photons that arrive at the boundary between pixels, and this could be used for subpixel localization of incident photons and enhanced spatial resolution.PurposeTo estimate improvements to spatial resolution and detective quantum efficiency that are possible when using coincidence counting for high‐resolution, non‐spectral imaging.MethodsThe modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE) were estimated using numerical simulations of a two‐dimensional parallel‐beam CT system. Coincidence counters were modeled either geometrically or with Monte Carlo simulations. The geometric model consisted of narrow coincidence counters that interlaced with wider ordinary pixels, and showed that using standard filtered backprojection decreases low‐frequency DQE, but that a frequency weighting technique could be used to restore DQE. The Monte Carlo simulations were used to estimate the possible improvements that could be expected from real systems. The pixel pitch was 0.25 mm and the source apertures considered were 0, 0.125, and 0.5 mm. A numerical stent phantom was also used to illustrate possible improvements.ResultsAssuming a 0.125 mm source aperture and the Monte Carlo model, the limiting MTF (at 10%) increased from 20 to 40 lp/cm using coincidence counters. This can be explained by the increased sampling (and higher Nyquist limit) possible from coincidence counters. In the geometric model, coincidence counters are compared to conventional double sampling techniques such as in‐plane flying focal spot, and the MTF at 38 lp/cm increased from 5% to 53%. Without the frequency weighting technique, low‐frequency DQE was reduced by about 20%, but these losses are recovered with frequency weighting. Improvements are much more modest with the 0.25 mm source aperture because the system becomes source‐limited.ConclusionsCoincidence counting could be used to increase spatial resolution in PCDs. The increases in system resolution could be large if a high‐resolution X‐ray source were available.

Abstract: Breast cancer1-associated protein 1 (BAP-1)-inactivated melanocytic tumors are a group of familial or sporadic lesions with distinctive histology and molecular features. Inherited germline inactivating mutations in BAP1 have been associated with the development of multiple epithelioid melanocytic neoplasms resembling Spitz nevi and increased susceptibility for developing several malignancies, including uveal melanoma, cutaneous melanoma, renal cell carcinoma, mesothelioma, and other tumors. Cutaneous melanoma with loss of BAP1 expression is rare. We present a unique case of BAP1 -inactivated melanoma with anaplastic lymphoma kinase ( ALK ) fusion arising in a pre-existing BAP1 -inactivated nevus in a 47-year-old female patient who presented with a dome-shaped red papule on the superior crus of the right antihelix. Histology revealed intradermal melanocytic proliferation with biphenotypic morphology. There was a proliferation of atypical melanocytes showing epithelioid features in the background of nevus. Mitotic figures were identified in the cytologically atypical component of the lesion. Mart-1/Ki67 dual stain demonstrated a higher proliferation index in the larger epithelioid atypical cells, supporting the diagnosis of melanoma. Nuclear BAP-1 expression was lost in the larger atypical cells and associated nevoid cells. Preferentially expressed antigen in melanoma stain demonstrated focal positive staining in 20%–30% of the melanocytes. Immunostaining for B-Raf proto-oncogene, serine/threonine kinase V600E was diffusely positive and ALK demonstrated patchy immunoreactivity in the melanocytic proliferation. Interphase fluorescence in situ hybridization studies showed gains at chromosome 6p25 (Ras responsive element binding protein 1) in the tumor cells. The comprehensive next-generation sequencing revealed B-Raf proto-oncogene, serine/threonine kinase V600E mutation, TP53 mutation, ALK fusion, BAP1 loss (copy number variation = 0.0, potentially germline), and loss of MAP2K7, Von Hippel-Lindau tumor suppressor , FGFR3, CDKN2A , 19q, and telomerase reverse transcriptase . The tumor was microsatellite stable with a low tumor mutational burden (5.76 mutations/Mb). The tumor was completely excised with negative margins. The patient is doing well at 17 months follow-up with no signs of recurrence.